评估南非因社区获得性感染住院的儿童进行实验室检测和使用抗菌药物的适宜性。
Evaluating the appropriateness of laboratory testing and antimicrobial use in South African children hospitalized for community-acquired infections.
机构信息
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
出版信息
PLoS One. 2022 Jul 28;17(7):e0272119. doi: 10.1371/journal.pone.0272119. eCollection 2022.
INTRODUCTION
Community acquired infection (CAI) is the leading indication for paediatric hospitalization in South Africa.
METHODS
We conducted secondary data analysis of prospective, consecutive paediatric admissions to Tygerberg Hospital (May 2015-November 2015). Clinical characteristics, admission diagnosis, appropriateness of diagnostic tests, use of antimicrobial prescriptions, hospital outcome and costs were analyzed.
RESULTS
CAI episodes were documented in (364/451; 81%) children admitted to the general paediatric ward; median age 4.8 months (Interquartile range, IQR, 1.5-17.5) and weight 5.4kg (IQR, 3.6-9.0). Male gender predominated (210/364; 58%), and Human Immunodeficiency Virus infection prevalence was 6.0% (22/364). Common CAI types included respiratory tract infections (197; 54%), gastroenteritis (51; 14%), and bloodstream infections (33; 9%). Pre-hospital antibiotics (ceftriaxone) were given to 152/364 (42%). Of 274 blood cultures and 140 cerebrospinal fluid samples submitted, 5% and 2% respectively yielded a pathogen. Common CAI antibiotic treatment regimens included: ampicillin alone (53%); ampicillin plus gentamicin (25%) and ampicillin plus cefotaxime (20%). Respiratory syncytial virus (RSV) was found in 39% of the children investigated for pneumonia. Most antibiotic prescriptions (323/364; 89%) complied with national guidelines and were appropriately adjusted based on the patient's clinical condition and laboratory findings. The overall estimated cost of CAI episode management ZAR 22,535 (≈1423 USD) per CAI admission episode. Unfavourable outcomes were uncommon (1% died, 4% required re-admission within 30 days of discharge).
CONCLUSION
CAI is the most frequent reason for hospitalization and drives antimicrobial use. Improved diagnostic stewardship is needed to prevent inappropriate antimicrobial prescriptions. Clinical outcome of paediatric CAI episodes was generally favourable.
简介
社区获得性感染（CAI）是南非儿科住院的主要指征。
方法
我们对 2015 年 5 月至 2015 年 11 月期间到泰格伯格医院连续收治的儿科患儿进行了二次数据分析。分析了临床特征、入院诊断、诊断性检查的适宜性、抗菌药物的使用、住院结局和费用。
结果
普通儿科病房收治的 451 名患儿中，有 364 例（81%）为 CAI 患儿；中位年龄 4.8 个月（四分位距，IQR，1.5-17.5），体重 5.4kg（IQR，3.6-9.0）。男性患儿占多数（210/364；58%），人类免疫缺陷病毒感染率为 6.0%（22/364）。常见的 CAI 类型包括呼吸道感染（197 例，54%）、胃肠炎（51 例，14%）和血流感染（33 例，9%）。364 例患儿中，152 例（42%）在院前使用了抗生素（头孢曲松）。274 份血培养和 140 份脑脊液标本中，分别有 5%和 2%检出病原体。常见的 CAI 抗生素治疗方案包括：单用氨苄西林（53%）、氨苄西林加庆大霉素（25%）和氨苄西林加头孢噻肟（20%）。对肺炎患儿进行检测发现，呼吸道合胞病毒（RSV）占 39%。大多数抗生素处方（323/364；89%）符合国家指南，并根据患者的临床状况和实验室结果进行了适当调整。每个 CAI 住院病例的管理费用估计为 22535 南非兰特（约合 1423 美元）。不良结局并不常见（1%死亡，4%出院后 30 天内再次入院）。
结论
CAI 是住院的最常见原因，也是导致抗菌药物使用的主要原因。需要加强诊断管理，以防止不适当的抗菌药物处方。儿科 CAI 患儿的临床结局总体良好。
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