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Abstract：
OBJECTIVE: This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with pediatric parapneumonic effusion/pleural empyema (PPE/PE).
METHODS: A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ2 test/Fisher exact test, Mann-Whitney U test and linear regression analysis adjusting for patient age where appropriate.
RESULTS: Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children.
CONCLUSIONS: This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
METHODS: A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ2 test/Fisher exact test, Mann-Whitney U test and linear regression analysis adjusting for patient age where appropriate.
RESULTS: Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children.
CONCLUSIONS: This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
摘要：
目的：本研究调查了经验性抗生素治疗（EAT），指导方针坚持，1402例小儿肺炎旁积液/胸膜脓胸(PPE/PE)住院患儿的抗生素精简和临床结局.
方法：一项全国性的监测研究收集了有关EAT的数据，临床病程/结果，病原体,2010年至2018年德国PPE/PE儿童的药敏试验和抗生素精简。亚组比较采用χ2检验/Fisher精确检验,在适当情况下调整患者年龄的Mann-WhitneyU检验和线性回归分析。
结果：提供了1402名儿童的完整EAT数据。在单药治疗的儿童（n=567）和2种抗生素联合治疗的儿童（n=589）中，最常用的抗生素是氨基青霉素/β-内酰胺酶抑制剂[138/567(24.3%)和102/589(17.3%)]和头孢呋辛[291/567(51.3%)和294/589(49.9%)].这些β-内酰胺类最常见的组合是大环内酯类，氨基糖苷类和克林霉素。我们观察到使用氨基青霉素/β-内酰胺酶抑制剂和头孢呋辛的EAT之间的临床严重程度/结果没有差异，无论是单药治疗还是2种抗生素联合治疗。肺炎链球菌的种类诊断（n=192），化脓性链球菌（n=111）或金黄色葡萄球菌（n=38）在聚合酶链反应或胸膜液或血液培养中导致9.4％的患者转向适当的窄谱β-内酰胺治疗，18.9%和5.2%的儿童。在有细菌药敏试验报告的儿童中，3/63(4.8%)的肺炎链球菌对青霉素耐药,10/32(31.3%)的儿童对金黄色葡萄球菌对甲氧西林耐药.
结论：本研究指出PPE/PE患儿的抗生素过度治疗，特别是经常使用抗生素的组合。接受抗生素联合治疗的儿童在临床结局上没有差异。即使在病原体检测后，使用简化的抗生素治疗的儿童比率也很低，这表明在PPE/PE中需要抗生素管理措施，并且需要研究其他潜在的治疗策略作为抗炎治疗。
方法：一项全国性的监测研究收集了有关EAT的数据，临床病程/结果，病原体,2010年至2018年德国PPE/PE儿童的药敏试验和抗生素精简。亚组比较采用χ2检验/Fisher精确检验,在适当情况下调整患者年龄的Mann-WhitneyU检验和线性回归分析。
结果：提供了1402名儿童的完整EAT数据。在单药治疗的儿童（n=567）和2种抗生素联合治疗的儿童（n=589）中，最常用的抗生素是氨基青霉素/β-内酰胺酶抑制剂[138/567(24.3%)和102/589(17.3%)]和头孢呋辛[291/567(51.3%)和294/589(49.9%)].这些β-内酰胺类最常见的组合是大环内酯类，氨基糖苷类和克林霉素。我们观察到使用氨基青霉素/β-内酰胺酶抑制剂和头孢呋辛的EAT之间的临床严重程度/结果没有差异，无论是单药治疗还是2种抗生素联合治疗。肺炎链球菌的种类诊断（n=192），化脓性链球菌（n=111）或金黄色葡萄球菌（n=38）在聚合酶链反应或胸膜液或血液培养中导致9.4％的患者转向适当的窄谱β-内酰胺治疗，18.9%和5.2%的儿童。在有细菌药敏试验报告的儿童中，3/63(4.8%)的肺炎链球菌对青霉素耐药,10/32(31.3%)的儿童对金黄色葡萄球菌对甲氧西林耐药.
结论：本研究指出PPE/PE患儿的抗生素过度治疗，特别是经常使用抗生素的组合。接受抗生素联合治疗的儿童在临床结局上没有差异。即使在病原体检测后，使用简化的抗生素治疗的儿童比率也很低，这表明在PPE/PE中需要抗生素管理措施，并且需要研究其他潜在的治疗策略作为抗炎治疗。
