Pediatric Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Sanitary Direction Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Ital J Pediatr. 2022 Dec 12;48(1):196. doi: 10.1186/s13052-022-01393-5.
Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella.
Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1 of November 2005 to the 1 of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered.
According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures.
Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization.
水痘被认为是一种轻度且自限性疾病，但在某些情况下，它可能会复杂化并需要住院治疗。抗生素不是首选治疗方法，但在某些情况下会被开处方，要么是为了治疗水痘相关并发症，要么是作为预防策略。本研究的目的是分析因水痘住院的儿科患者使用抗生素的比率和模式，以及相关费用，以增加对水痘中抗生素使用的了解。
2005 年 11 月 1 日至 2021 年 11 月 1 日期间，在意大利罗马的 Bambino Gesù 儿童 IRCCS 医院因水痘住院的年龄小于 18 岁的患者纳入本研究。从医院的电子病历数据库中收集回顾性数据。考虑了抗生素的使用率、模式和费用。
根据纳入标准，我们共纳入 810 名患者，中位年龄为 2.4 岁。其中 345 名患者（42.6%）接受了抗生素治疗，其中 307 名用于治疗并发症（90.0%），其余 10.0%用于预防并发症。水痘住院费用为 2928749 欧元（中位数费用为 2689 欧元）。至于抗生素治疗，它占总费用的 5.9%（174527 欧元），中位数费用为 198.8 欧元。接受抗生素治疗的患者费用明显高于未接受抗生素治疗的患者（p 值<0.0001），住院时间也更长（p 值<0.0001）。最常开的抗生素是阿莫西林克拉维酸和头孢曲松，分别占所有抗生素处方的 36.0%和 25.0%。抗生素可能会对住院的经济成本产生负面影响，而且处方并不总是符合指南，这可能会对抗生素耐药性的发展产生重要影响。实际上，抗生素耐药性被认为是对世界人口未来健康的主要威胁，因为它可能导致住院时间延长、死亡率增加、医疗保健成本增加和治疗失败。
降低经济成本、住院时间和抗生素耐药性的策略包括确保经验性抗生素的合理处方和管理，以及通过免疫接种减少可预防传染病的传播。
