Hall Eric W, Tippett Ashley, Fridkin Scott, Anderson Evan J, Lopman Ben, Benkeser David, Baker Julia M
School of Public Health, Oregon Health and Science University, Portland, Oregon, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2022 Jun 9;9(7):ofac276. doi: 10.1093/ofid/ofac276. eCollection 2022 Jul.
Vaccines may play a role in controlling the spread of antibiotic resistance. However, it is unknown if rotavirus vaccination affects antibiotic use in the United States (US).
Using data from the IBM MarketScan Commercial Database, we conducted a retrospective cohort of US children born between 2007 and 2018 who were continuously enrolled for the first 8 months of life (N = 2 136 136). We followed children through 5 years of age and compared children who completed a full rotavirus vaccination series by 8 months of age to children who had not received any doses of rotavirus vaccination. We evaluated antibiotic prescriptions associated with an acute gastroenteritis (AGE) diagnosis and defined the switching of antibiotics as the prescription of a second, different antibiotic within 28 days. Using a stratified Kaplan-Meier approach, we estimated the cumulative incidence for each study group, adjusted for receipt of pneumococcal conjugate vaccine, provider type, and urban/rural status.
Overall, 0.8% (n = 17 318) of participants received an antibiotic prescription following an AGE diagnosis. The 5-year adjusted relative cumulative incidence of antibiotic prescription following an AGE diagnosis was 0.793 (95% confidence interval [CI], .761-.827) among children with complete rotavirus vaccination compared to children without rotavirus vaccination. Additionally, children with complete vaccination were less likely to switch antibiotics (0.808 [95% CI, .743-.887]). Rotavirus vaccination has averted an estimated 67 045 (95% CI, 53 729-80 664) antibiotic prescriptions nationally among children born between 2007 and 2018.
These results demonstrate that rotavirus vaccines reduce antibiotic prescribing for AGE, which could help reduce the growth of antibiotic resistance.
疫苗可能在控制抗生素耐药性传播方面发挥作用。然而，轮状病毒疫苗接种是否会影响美国的抗生素使用尚不清楚。
利用IBM MarketScan商业数据库的数据，我们对2007年至2018年出生的美国儿童进行了一项回顾性队列研究，这些儿童在出生后的前8个月持续参保（N = 2136136）。我们对儿童进行了5年的随访，并将8个月龄前完成完整轮状病毒疫苗接种系列的儿童与未接种任何剂量轮状病毒疫苗的儿童进行了比较。我们评估了与急性胃肠炎（AGE）诊断相关的抗生素处方，并将抗生素换药定义为在28天内开具第二种不同的抗生素处方。采用分层Kaplan-Meier方法，我们估计了每个研究组的累积发病率，并对肺炎球菌结合疫苗接种情况、医疗服务提供者类型和城乡状况进行了调整。
总体而言，0.8%（n = 17318）的参与者在AGE诊断后接受了抗生素处方。与未接种轮状病毒疫苗的儿童相比，完成轮状病毒疫苗接种的儿童在AGE诊断后5年调整后的抗生素处方相对累积发病率为0.793（95%置信区间[CI]，0.761 - 0.827）。此外，完成疫苗接种的儿童更换抗生素的可能性较小（0.808[95%CI，0.743 - 0.887]）。在2007年至2018年出生的儿童中，轮状病毒疫苗接种在全国范围内避免了估计67045例（95%CI，53729 - 80664）抗生素处方。
这些结果表明，轮状病毒疫苗可减少AGE的抗生素处方，这有助于减少抗生素耐药性的增长。
