Hung Chi-Wen, Chen Solomon Chih-Chen, Ku Li-Jung Elizabeth, Sheu Bor-Shyang, Yang Yao-Jong
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Pediatrics and Institute of Clinical Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.
Front Pediatr. 2022 May 3;10:860960. doi: 10.3389/fped.2022.860960. eCollection 2022.
infection is a major cause of peptic ulcers and gastric cancer. This study aimed to compare the eradication rate and essential costs of culture-based and empiric therapy strategies in treating pediatric infection.
We retrospectively enrolled patients aged <18 years with a diagnosis of infection who received esophagogastroduodenoscopy at two medical centers in southern Taiwan from 1998 to 2018. Patients with positive cultures and minimum inhibitory concentration test results were allocated to a culture-based strategy, and those with negative cultures or without culture as an empiric therapy strategy. We collected demographic data and eradication rates, and calculated the total essential costs of treating a hypothetical cohort of 1,000 pediatric patients based on the two strategies.
Ninety-six patients were enrolled, of whom 55 received a culture-based strategy and 41 received an empiric therapy strategy. The eradication rates with the first treatment were 89.1 and 75.6% in the culture-based and empiric therapy strategy, respectively. There were no significant differences in age, sex, and endoscopic diagnosis between the two strategies. For every 10% increase in those receiving a culture-based strategy, the total cost would have been reduced by US$466 in a hypothetical cohort of 1,000 patients. For every 10% increase in successful eradication rate, the total cost was reduced by US$24,058 with a culture-based strategy and by US$20,241 with an empiric therapy strategy.
A culture-based strategy was more cost effective than an empiric therapy strategy in treating pediatric -infected patients.
感染是消化性溃疡和胃癌的主要病因。本研究旨在比较基于培养的治疗策略和经验性治疗策略在治疗儿童感染方面的根除率和基本成本。
我们回顾性纳入了1998年至2018年在台湾南部两个医疗中心接受食管胃十二指肠镜检查、年龄<18岁且诊断为感染的患者。培养结果为阳性且有最低抑菌浓度测试结果的患者被分配到基于培养的治疗策略组，培养结果为阴性或未进行培养的患者则采用经验性治疗策略。我们收集了人口统计学数据和根除率，并根据这两种策略计算了治疗1000名儿童患者这一假设队列的总基本成本。
共纳入96例患者，其中55例接受基于培养的治疗策略，41例接受经验性治疗策略。在基于培养的治疗策略和经验性治疗策略中，首次治疗的根除率分别为89.1%和75.6%。两种策略在年龄、性别和内镜诊断方面无显著差异。在1000名患者的假设队列中，接受基于培养的治疗策略的患者每增加10%，总成本将降低466美元。对于基于培养的治疗策略，根除成功率每提高10%，总成本降低24,058美元；对于经验性治疗策略，根除成功率每提高10%，总成本降低20,241美元。
在治疗儿童感染患者方面，基于培养的治疗策略比经验性治疗策略更具成本效益。
