Bentouhami Hayat, Bungwa Milcah Kahkelam, Casas Lidia, Coenen Samuel, Weyler Joost
Department of Family Medicine & Population Health (FAMPOP), Social Epidemiology and Health Policy (SEHPO), University of Antwerp, Antwerp, Belgium.
Department of Family Medicine & Population Health (FAMPOP), Primary Care & Interdisciplinary Care Antwerp (ELIZA), University of Antwerp, Antwerp, Belgium.
Allergy Asthma Clin Immunol. 2023 Mar 6;19(1):18. doi: 10.1186/s13223-023-00773-8.
Results of studies evaluating the relationship between asthma occurrence and early life antibiotic use have been conflicting. The aim of this study was to investigate the relationship between occurrence of asthma in children and systemic antibiotic use in the first year of life based on an incidence density study with careful consideration of the temporal aspects of the determinant-outcome relationship.
We conducted an incidence density study nested in a data collection project with information on 1128 mother-child pairs. Systemic antibiotic use in the first year of life was defined as excessive (≥ 4 courses) vs. non-excessive (< 4 courses) use based on information from weekly diaries. Events (cases) were defined as the first parent-reported occurrence of asthma in a child between 1 and 10 years of age. Population time 'at risk' was probed by sampling population moments (controls). Missing data were imputed. Multiple logistic regression was used to assess the association between current first asthma occurrence (incidence density) and systemic antibiotic use in the first year of life, to evaluate effect modification and adjust for confounding.
Forty-seven first asthma events and 147 population moments were included. Excessive systemic antibiotic use in the first year of life showed more than twice the incidence density of asthma compared to non-excessive use (adjusted IDR [95% CI]: 2.18 [0.98, 4.87], p = 0.06). The association was more pronounced in children who have had lower respiratory tract infections (LRTIs) in the first year of life compared to children who had no LRTIs in the first year of life (adjusted IDR [95% CI]: 5.17 [1.19, 22.52] versus 1.49 [0.54, 4.14]).
Excessive use of systemic antibiotics in the first year of life may play a role in the genesis of asthma in children. This effect is modified by the occurrence of LRTIs in the first year of life, with a stronger association observed in children experiencing LRTIs in the first year of life.
评估哮喘发生与早期抗生素使用之间关系的研究结果一直存在矛盾。本研究的目的是基于发病率密度研究，仔细考虑决定因素与结果关系的时间因素，调查儿童哮喘发生与出生后第一年全身使用抗生素之间的关系。
我们在一个数据收集项目中进行了一项发病率密度研究，该项目包含1128对母婴的信息。根据每周日记中的信息，将出生后第一年全身使用抗生素定义为过量（≥4个疗程）与不过量（<4个疗程）使用。事件（病例）定义为父母首次报告的1至10岁儿童哮喘发作。通过对人群时刻（对照）进行抽样来探究人群的“风险时间”。对缺失数据进行插补。采用多因素logistic回归评估当前首次哮喘发作（发病率密度）与出生后第一年全身使用抗生素之间的关联，评估效应修饰并调整混杂因素。
纳入了47例首次哮喘事件和147个人群时刻。与不过量使用相比，出生后第一年全身使用抗生素过量的哮喘发病率密度高出两倍多（调整后的发病率比[95%置信区间]：2.18[0.98,4.87]，p = 0.06）。与出生后第一年未患下呼吸道感染（LRTIs）的儿童相比，出生后第一年患LRTIs的儿童这种关联更为明显（调整后的发病率比[95%置信区间]：5.17[1.19,22.52]对1.49[0.54,4.14]）。
出生后第一年全身使用抗生素过量可能在儿童哮喘的发生中起作用。这种效应因出生后第一年LRTIs的发生而改变，在出生后第一年患LRTIs的儿童中观察到更强的关联。
