Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel.
Hum Vaccin Immunother. 2024 Dec 31;20(1):2396707. doi: 10.1080/21645515.2024.2396707. Epub 2024 Sep 9.
Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0-59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008-2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011-2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1-20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31-0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73-5.23]), blood (3.29 [95% CI 1.85-5.86]) and urine cultures (7.12 [3.77-13.43]), levels of C-reactive protein (1.02 [1.01-1.02]) and leukocytes (1.05 [1.01-1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.
在急性病毒性肠胃炎（AGE）患儿中使用抗生素的证据不足。我们对因病毒性 AGE 住院的患儿中抗生素使用的程度和相关因素进行了描述。这是一项单中心研究，纳入了 2008 年至 2015 年期间在以色列因 AGE 住院的 0-59 月龄儿童。研究收集了实验室检查、诊断、抗生素治疗和轮状病毒疫苗接种的信息。对粪便样本进行了轮状病毒抗原、GII-诺如病毒检测，对粪便培养进行了细菌肠道病原体检测。共分析了 2240 名儿童的数据。有 79%的合格儿童接种了轮状病毒疫苗。对 1419 名（63.3%）儿童进行了轮状病毒检测。在轮状病毒疫苗普遍接种（2008-2010 年）之前，粪便样本中轮状病毒阳性率为 37.0%，在普遍接种年份（2011-2015 年）降至 17.3%。总体而言，共有 1395 名患儿患有病毒性 AGE。其中，253 名（18.1%[95%CI 16.1-20.2]）接受了不必要的抗生素治疗，主要是青霉素 46.6%、头孢曲松 34.0%和阿奇霉素 21.7%。多变量分析显示，轮状病毒疫苗接种与不必要的抗生素治疗呈负相关（比值比=0.53[95%CI 0.31-0.91]），而与进行胸部 X 光检查（3.00[1.73-5.23]）、血液（3.29[95%CI 1.85-5.86]）和尿液培养（7.12[3.77-13.43]）、C 反应蛋白（1.02[1.01-1.02]）和白细胞（1.05[1.01-1.09]）水平呈正相关。在对实验室确诊的轮状病毒或诺如病毒 AGE 患儿或排除 C 反应蛋白>50mg/L 的患儿进行分析时，结果一致。总之，病毒性 AGE 住院患儿的抗生素处方很常见，与轮状病毒疫苗接种呈负相关，这可能是由于接种疫苗的患儿病情较轻。
