水痘感染的识别和管理以及抗菌药物建议的准确性：美国病例实例研究。
Recognition & management of varicella infections and accuracy of antimicrobial recommendations: Case vignettes study in the US.
机构信息
Driscoll Children's Hospital, Corpus Christi, Texas, United States of America.
Merck & Co. Inc., Rahway, New Jersey, United States of America.
出版信息
PLoS One. 2022 Jun 24;17(6):e0269596. doi: 10.1371/journal.pone.0269596. eCollection 2022.
BACKGROUND
In 1995, the CDC recommended one-dose routine varicella immunization for children <12 years of age, expanding its recommendation to two doses in 2006. Today, with widespread varicella vaccination coverage, an estimated 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented annually in the United States. Since varicella infections are now uncommon, health care providers (HCPs) may not recognize varicella infections and may prescribe inappropriate treatment.
METHODS
An online survey of HCPs was conducted to assess recognition and management of varicella infections. Responses to eight varicella vignettes describing patients with varying varicella symptoms were analyzed and descriptive analyses performed. Stratified analysis comparing responses of those licensed before and in/after 1996 was also performed.
RESULTS
153 HCPs (50 nurse practitioners, 103 doctors) completed the survey. Mean age of respondents was 44 years. 62% were female, and 82% were licensed before 1996. Varicella infection was correctly diagnosed 79% of the time. HCPs correctly recognized uncomplicated varicella vignettes 85% of the time versus 61% of the time for complicated varicella vignettes. Antibiotics were recommended 17% of the time and antivirals 18% of the time, of which 25% and 69% (respectively) were not appropriate per guidelines. HCPs licensed before 1996 were better able to recognize varicella compared to those licensed later, but prescribed more antimicrobials medications to treat varicella.
CONCLUSIONS
Although most HCPs recognized varicella infection, a sizable proportion could not recognize cases with complications, and some of the varicella cases were inappropriately treated with antibiotics and/or antivirals. Additional HCP training and high vaccination coverage are important strategies to avoid inaccurate diagnoses and minimize unnecessary exposure to antimicrobial/antiviral therapies.
背景
1995 年，疾病预防控制中心（CDC）建议对 12 岁以下儿童进行一剂常规水痘免疫接种，并在 2006 年将其推荐剂量扩大至两剂。如今，由于水痘疫苗接种广泛普及，美国每年可预防约 350 万例水痘、9000 例住院和 100 例死亡。由于现在水痘感染并不常见，医疗保健提供者（HCP）可能无法识别水痘感染，并且可能开具不适当的治疗方法。
方法
对 HCP 进行了在线调查，以评估对水痘感染的识别和管理。对描述不同水痘症状患者的八个水痘病例进行了分析，并进行了描述性分析。还对在 1996 年之前和之后获得许可的 HCP 进行了分层分析。
结果
共有 153 名 HCP（50 名执业护士，103 名医生）完成了调查。受访者的平均年龄为 44 岁。62%为女性，82%在 1996 年之前获得许可。水痘感染的正确诊断率为 79%。HCP 正确识别出单纯性水痘病例的比例为 85%，而识别出复杂性水痘病例的比例为 61%。抗生素的推荐率为 17%，抗病毒药物的推荐率为 18%，其中分别有 25%和 69%（分别）不符合指南。与 1996 年之后获得许可的 HCP 相比，1996 年之前获得许可的 HCP 更能识别水痘，但用于治疗水痘的抗生素药物更多。
结论
尽管大多数 HCP 能够识别水痘感染，但仍有相当一部分 HCP 无法识别出有并发症的病例，并且一些水痘病例被不合理地用抗生素和/或抗病毒药物治疗。额外的 HCP 培训和高疫苗接种覆盖率是避免不准确诊断和尽量减少不必要使用抗生素/抗病毒治疗的重要策略。
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