Pediatric Infection and Vaccine

  • 제24권2호
  • /
  • Pages.87-94
  • /
  • 2017
  • /
  • 2384-1079(pISSN)
  • /
  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지
DOI QR코드

DOI QR Code

상기도 감염으로 입원한 소아환자에서 항생제 사용에 대한 후향적 분석

A Retrospective Analysis of Use in Hospitalized Children with Upper Respiratory Tract Infection

  • 정민영 (고신대학교 의과대학 소아과학교실) ;
  • 박지현 (고신대학교 의과대학 소아과학교실) ;
  • 오지은 (고신대학교 의과대학 소아과학교실)
  • Jung, Minyoung (Department of Pediatrics, Kosin University College of Medicine) ;
  • Park, Ji Hyun (Department of Pediatrics, Kosin University College of Medicine) ;
  • Oh, Chi Eun (Department of Pediatrics, Kosin University College of Medicine)
  • 투고 : 2016.09.22
  • 심사 : 2016.12.26
  • 발행 : 2017.08.25
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 상기도 감염인 소아에게 항생제를 처방하는 것은 아직도 많은 진료실에서 이루어지고 있다. 이 연구는 역전사 중합효소연쇄반응 검사로 호흡기 바이러스가 확인된 이후에도 항생제를 사용한 소아 환자들의 임상적 특징을 조사하고자 하였다. 방법: 2013년 1월부터 2014년 11월에 고신대학교 복음병원 소아청소년과에 상기도 감염으로 입원한 환자 중 역전사 중합효소연쇄반응을 시행한 환자들을 대상으로 후향적 의무기록 분석을 통해 평가하였다. 결과: 상기도 감염으로 진단받은 393명 중 전체 환자 연령의 중앙값은 23개월이었다. 입원 당시 항생제를 처방받은 환자(79명, 20.1%)와 항생제를 처방받지 않은 환자들의 임상적 요인을 비교할 때, 중이염 또는 부비동염의 동반, 높은 고감도 C-반응단백질의 수치가 항생제 처방과 의미 있게 관련 있었다(P<0.001). 입원하여 항생제를 사용하던 중 역전사 중합효소연쇄반응 방법으로 호흡기 바이러스가 확인되었지만, 항생제를 계속 사용한 환자는 44명 중 28명(63.6%)이었다. 항생제를 계속 사용한 환자는 항생제를 중단한 환자와 비교할 때 중이염 동반 비율이 유의하게 높았다(75% vs. 25%, P=0.002). 결론: 본 연구에서 상기도 감염의 원인이 바이러스임을 확인된 소아 환자에게서도 항생제를 지속한 주된 이유는 중이염이 동반되었기 때문이었다. 중이염을 정확하게 진단하고 그 중 항생제가 꼭 필요한 경우를 가려낸다면 소아 상기도 감염에서 불필요한 항생제 사용을 줄이는 데 도움이 될 것으로 생각된다.

Purpose: The inappropriate prescription of antibiotics in children with upper respiratory tract infection (URTI) is common. This study evaluated the factors that influence antibiotics use in hospitalized children with viral URTI confirmed by reverse transcriptase-polymerase chain reaction (RTPCR) assay. Methods: The medical records of admitted patients who performed RT-PCR assay for respiratory virus pathogens from January 2013 to November 2014 were examined. The demographic and clinical features were compared between patients who were administered antibiotics at admission and those who were not. We also investigated differences between children who continued antibiotics and those who stopped antibiotics after a viral pathogen was identified. Results: In the total 393 inpatients, the median age was 23 months (interquartile range, 13 to 41.3 months). Antimicrobial agents were prescribed in 79 patients (20.1%) at admission. Patients with acute otitis media (AOM) had higher rates of antibiotics prescription than those without AOM (48.1% vs. 2.2%, P<0.001), with an adjusted odds ratio of 91.1 (95% confidence interval, 30.5 to 271.7). Level of high-sensitivity C-reactive protein and the proportion of acute rhinosinusitis were also significantly associated with antibiotics use (P<0.001). Among the 44 patients with viruses identified using the RT-PCR method during hospitalization, antibiotic use was continued in 28 patients (63.6%). AOM was statistically associated with continued antibiotic use in the patients (P=0.002). Conclusions: Although the respiratory virus responsible for URTI etiology is identified, clinicians might not discontinue antibiotics if AOM is accompanying. Therefore, careful diagnosis and management of AOM could be a strategy to reduce unjustified antibiotic prescriptions for children with URTI.

키워드

참고문헌

  1. Monto AS. Epidemiology of viral respiratory infections. Am J Med 2002;112 Suppl 6A:4S-12S.
  2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016;315:1864-73. https://doi.org/10.1001/jama.2016.4151
  3. Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011;128:1053-61. https://doi.org/10.1542/peds.2011-1337
  4. Shin SM, Shin JY, Kim MH, Lee SH, Choi S, Park BJ. Prevalence of antibiotic use for pediatric acute upper respiratory tract infections in Korea. J Korean Med Sci 2015;30:617-24. https://doi.org/10.3346/jkms.2015.30.5.617
  5. Grijalva CG, Nuorti JP, Griffin MR. Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings. JAMA 2009;302:758-66. https://doi.org/10.1001/jama.2009.1163
  6. Mangione-Smith R, Wong L, Elliott MN, McDonald L, Roski J. Measuring the quality of antibiotic prescribing for upper respiratory infections and bronchitis in 5 US health plans. Arch Pediatr Adolesc Med 2005;159:751-7. https://doi.org/10.1001/archpedi.159.8.751
  7. Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013;132:1146-54. https://doi.org/10.1542/peds.2013-3260
  8. van de Pol AC, Wolfs TF, Tacke CE, Uiterwaal CS, Forster J, van Loon AM, et al. Impact of PCR for respiratory viruses on antibiotic use: theory and practice. Pediatr Pulmonol 2011;46:428-34.
  9. Sharma V, Dowd MD, Slaughter AJ, Simon SD. Effect of rapid diagnosis of influenza virus type a on the emergency department management of febrile infants and toddlers. Arch Pediatr Adolesc Med 2002;156:41-3. https://doi.org/10.1001/archpedi.156.1.41
  10. Byington CL, Castillo H, Gerber K, Daly JA, Brimley LA, Adams S, et al. The effect of rapid respiratory viral diagnostic testing on antibiotic use in a children's hospital. Arch Pediatr Adolesc Med 2002;156:1230-4. https://doi.org/10.1001/archpedi.156.12.1230
  11. Doan QH, Kissoon N, Dobson S, Whitehouse S, Cochrane D, Schmidt B, et al. A randomized, controlled trial of the impact of early and rapid diagnosis of viral infections in children brought to an emergency department with febrile respiratory tract illnesses. J Pediatr 2009;154:91-5. https://doi.org/10.1016/j.jpeds.2008.07.043
  12. Krause JC, Panning M, Hengel H, Henneke P. The role of multiplex PCR in respiratory tract infections in children. Dtsch Arztebl Int 2014;111:639-45.
  13. Pozzetto B, Grattard F, Pillet S. Multiplex PCR theranostics of severe respiratory infections. Expert Rev Anti Infect Ther 2010;8:251-3. https://doi.org/10.1586/eri.09.131
  14. Wishaupt JO, Russcher A, Smeets LC, Versteegh FG, Hartwig NG. Clinical impact of RT-PCR for pediatric acute respiratory infections: a controlled clinical trial. Pediatrics 2011;128:e1113-20. https://doi.org/10.1542/peds.2010-2779
  15. Chonmaitree T, Alvarez-Fernandez P, Jennings K, Trujillo R, Marom T, Loeffelholz MJ, et al. Symptomatic and asymptomatic respiratory viral infections in the first year of life: association with acute otitis media development. Clin Infect Dis 2015;60:1-9. https://doi.org/10.1093/cid/ciu714
  16. Stockmann C, Ampofo K, Hersh AL, Carleton ST, Korgenski K, Sheng X, et al. Seasonality of acute otitis media and the role of respiratory viral activity in children. Pediatr Infect Dis J 2013;32:314-9. https://doi.org/10.1097/INF.0b013e31827d104e
  17. Health Insurance Review & Assessment Service. The results of appropriate antibiotics prescription in chilren with acute otitis media 2013 [Internet]. Wonju: HIRA; c2013 [cited 2017 Jun 10]. Available from: http://www.hira.or.kr.
  18. Venekamp RP, Sanders SL, Glasziou PP, Del Mar CB, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2015;(6):CD000219.
  19. Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131:e964-99. https://doi.org/10.1542/peds.2012-3488
  20. Vouloumanou EK, Karageorgopoulos DE, Kazantzi MS, Kapaskelis AM, Falagas ME. Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials. J Antimicrob Chemother 2009;64:16-24. https://doi.org/10.1093/jac/dkp166
  21. Kitamura K, Iino Y, Kamide Y, Kudo F, Nakayama T, Suzuki K, et al. Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan: 2013 update. Auris Nasus Larynx 2015;42:99-106. https://doi.org/10.1016/j.anl.2014.09.006
  22. Kalu SU, Ataya RS, McCormick DP, Patel JA, Revai K, Chonmaitree T. Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection. Pediatr Infect Dis J 2011;30:95-9. https://doi.org/10.1097/INF.0b013e3181f253d5
  23. Uitti JM, Tahtinen PA, Laine MK, Ruohola A. Close followup in children with acute otitis media initially managed without antimicrobials. JAMA Pediatr 2016;170:1107-8. https://doi.org/10.1001/jamapediatrics.2016.1542
  24. Toikka P, Irjala K, Juven T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000;19:598-602. https://doi.org/10.1097/00006454-200007000-00003
  25. Putto A, Ruuskanen O, Meurman O, Ekblad H, Korvenranta H, Mertsola J, et al. C reactive protein in the evaluation of febrile illness. Arch Dis Child 1986;61:24-9. https://doi.org/10.1136/adc.61.1.24
  26. Huijskens EG, Biesmans RC, Buiting AG, Obihara CC, Rossen JW. Diagnostic value of respiratory virus detection in symptomatic children using real-time PCR. Virol J 2012;9:276. https://doi.org/10.1186/1743-422X-9-276
  27. van Woensel JB, van Aalderen WM, Kimpen JL. Viral lower respiratory tract infection in infants and young children. BMJ 2003;327:36-40. https://doi.org/10.1136/bmj.327.7405.36
  28. Oosterheert JJ, van Loon AM, Schuurman R, Hoepelman AI, Hak E, Thijsen S, et al. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 2005;41:1438-44. https://doi.org/10.1086/497134
  29. Rhedin S, Lindstrand A, Rotzen-Ostlund M, Tolfvenstam T, Ohrmalm L, Rinder MR, et al. Clinical utility of PCR for common viruses in acute respiratory illness. Pediatrics 2014;133:e538-45. https://doi.org/10.1542/peds.2013-3042