Del Rosal Teresa, Bote-Gascón Patricia, Falces-Romero Iker, Sainz Talía, Baquero-Artigao Fernando, Rodríguez-Molino Paula, Méndez-Echevarría Ana, Bravo-Queipo-de-Llano Blanca, Alonso Luis A, Calvo Cristina
Pediatrics and Infectious Diseases Department, Institute for Health Research IdiPAZ, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Translational Research Network in Pediatric Infectious Diseases (RITIP), 28046 Madrid, Spain.
Children (Basel). 2024 Feb 15;11(2):245. doi: 10.3390/children11020245.
Antibiotics are frequently prescribed to children with pneumonia, although viruses are responsible for most cases. We aimed to evaluate the impact of multiplex polymerase chain reaction (mPCR) on antibiotic use. We conducted a prospective study of children under 14 years of age admitted for suspected viral pneumonia, from October 2019 to June 2022 (except March-November 2020). A mPCR respiratory panel (FilmArray 2, bioMérieux, Marcy-l'Étoile, France) was performed within 72 h of admission. Patients with positive reverse transcription PCR for respiratory syncytial virus, influenza, or SARS-CoV-2 were excluded. We compared the patients with historical controls (2017-2018) who had suspected viral pneumonia but did not undergo an aetiological study. We included 64 patients and 50 controls, with a median age of 26 months. The respiratory panel detected viral pathogens in 55 patients (88%), including 17 (31%) with co-infections. Rhinovirus/enterovirus ( = 26) and human metapneumovirus ( = 22) were the most common pathogens, followed by adenovirus and parainfluenza ( = 10). There were no statistically significant differences in the total antibiotic consumption (83% of cases and 86% of controls) or antibiotics given for ≥72 h (58% vs. 66%). Antibiotics were prescribed in 41% of the cases and 72% of the controls at discharge ( = 0.001). Ampicillin was the most commonly prescribed antibiotic among the patients (44% vs. 18% for controls, = 0.004), while azithromycin was the most commonly prescribed among the controls (19% vs. 48% for patients and controls, respectively; = 0.001). Our findings underscore the need for additional interventions alongside molecular diagnosis to reduce antibiotic usage in paediatric community-acquired pneumonia.
尽管大多数肺炎病例是由病毒引起的，但抗生素仍经常被开给患有肺炎的儿童。我们旨在评估多重聚合酶链反应（mPCR）对抗生素使用的影响。我们对2019年10月至2022年6月（2020年3月至11月除外）因疑似病毒性肺炎入院的14岁以下儿童进行了一项前瞻性研究。在入院72小时内进行了mPCR呼吸道检测（FilmArray 2，生物梅里埃公司，法国马西伊图瓦勒）。呼吸道合胞病毒、流感或SARS-CoV-2逆转录PCR呈阳性的患者被排除。我们将这些患者与2017 - 2018年疑似病毒性肺炎但未进行病因学研究的历史对照组进行了比较。我们纳入了64例患者和50例对照，中位年龄为26个月。呼吸道检测在55例患者（88%）中检测到病毒病原体，其中17例（31%）为合并感染。鼻病毒/肠道病毒（= 26）和人偏肺病毒（= 22）是最常见的病原体，其次是腺病毒和副流感病毒（= 10）。总抗生素消耗量（病例组83%，对照组86%）或使用抗生素≥72小时的情况（58%对66%）没有统计学上的显著差异。出院时，41%的病例和72%的对照使用了抗生素（= 0.001）。氨苄西林是患者中最常使用的抗生素（44%对对照组的18%，= 0.004），而阿奇霉素是对照组中最常使用的抗生素（分别为19%对患者组的48%；= 0.001）。我们的研究结果强调，除分子诊断外，还需要采取额外干预措施以减少儿童社区获得性肺炎中的抗生素使用。
