Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Porter School of Environmental and Earth Sciences, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel.
Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel.
J Glob Antimicrob Resist. 2021 Dec;27:303-308. doi: 10.1016/j.jgar.2021.10.015. Epub 2021 Oct 28.
Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infections, especially in young children. Antibiotics are often unnecessarily prescribed for the treatment of RSV. Such treatments affect antibiotic resistance in future bacterial infections of treated patients and the general population. This study aimed to understand risk factors for and patterns of unnecessary antibiotic prescription in children with RSV.
In a single-centre, retrospective study in Israel, we obtained data for children aged ≤2 years (n = 1016) hospitalised for RSV bronchiolitis during 2008-2018 and ascertained not to have bacterial co-infections. Antibiotic misuse was defined as prescription of antibiotics during hospitalisation of the study population. Demographic and clinical variables were assessed as predictors of unnecessary antibiotic treatment in a multivariable logistic regression model.
The unnecessary antibiotic treatment rate of children infected with RSV and ascertained not to have a bacterial co-infection was estimated at 33.4% (95% CI 30.5-36.4%). An increased likelihood of antibiotic misuse was associated with drawing bacterial cultures and with variables indicative of a severe patient status such as lower oxygen saturation, higher body temperature, tachypnoea and prior recent emergency room visit. Older age and female sex were also associated with an increased likelihood of unnecessary antibiotic treatment.
Unnecessary antibiotic treatment in RSV patients was very common and may be largely attributed to physicians' perception of patients' severity. Improving prescription guidelines, implementing antibiotic stewardship programmes and utilising decision support systems may help achieve a better balance between prescribing and withholding antibiotic treatment.
呼吸道合胞病毒（RSV）是呼吸道感染的主要原因，尤其是在幼儿中。抗生素常被不必要地用于治疗 RSV。这种治疗会影响治疗患者和普通人群未来细菌感染的抗生素耐药性。本研究旨在了解导致儿童 RSV 不必要抗生素处方的危险因素和模式。
在以色列的一项单中心回顾性研究中，我们获得了 2008 年至 2018 年期间因 RSV 细支气管炎住院的≤2 岁儿童（n=1016）的数据，且这些儿童没有细菌合并感染。抗生素使用不当定义为在研究人群住院期间开具抗生素。在多变量逻辑回归模型中，评估了人口统计学和临床变量作为不必要抗生素治疗的预测因素。
确定未合并细菌感染的 RSV 感染儿童的不必要抗生素治疗率估计为 33.4%（95%CI 30.5-36.4%）。使用抗生素的可能性增加与细菌培养以及与患者病情严重程度相关的变量有关，例如较低的氧饱和度、较高的体温、呼吸急促和最近的急诊室就诊。年龄较大和女性也与不必要抗生素治疗的可能性增加相关。
RSV 患者的不必要抗生素治疗非常普遍，可能主要归因于医生对患者病情严重程度的看法。改进处方指南、实施抗生素管理计划和利用决策支持系统可能有助于在开具和不使用抗生素治疗之间取得更好的平衡。
