PDF(Pubmed)
Abstract：
Inappropriate antibiotic use contributes to antimicrobial resistance, a global public health threat. The non-specific manifestations of dengue, itself a growing public health threat, lead to avoidable empiric antibiotic prescription, particularly in children. In this national pooled population-based cross-sectional study, we evaluated child and physician characteristics associated with antibiotics prescription in confirmed dengue cases in Taiwan. Linking national health care insurance claims and reports of confirmed dengue cases from 2008 to 2015, there were 7086 children with confirmed dengue with 21 744 outpatient visits and 2520 inpatient admissions. We assessed the presence of antibiotic prescription in outpatient and inpatient settings separately a week before or after the confirmation date. Logistic regression models with generalized estimating equations were applied to identify patient, practitioner, and other factors associated with antibiotic prescription. A total of 29.4% of children <18 years old with dengue who did not have a concomitant bacterial infection were prescribed antibiotics during the 14-day assessment period. Antibiotics prescription was reduced from 13.5% to 6.3% and from 43.2% to 19.3% in outpatient and inpatient settings, respectively, after dengue was confirmed. Young children were more likely to receive antibiotics. Significant variations in antibiotic prescribing across physicians were observed only in outpatient settings: physicians ≥60 years old and physicians practicing at clinics and in non-urban facilities were more likely to prescribe antibiotics. Antibiotics were less likely to be prescribed during an exceptional 2-year epidemic than in other years. Antibiotic prescribing for dengue, an arboviral infection affecting half of the global population, was shown to occur in 29% of paediatric cases in Taiwan. That potentially avoidable antibiotic consumption could be reduced by improving antibiotic stewardship, informed by understanding the conditions under which antibiotics are prescribed and the availability of prevention strategies for viral diseases, including dengue. We identified a number of such factors in this national population-based study.
摘要：
背景：不适当的抗生素使用会导致抗菌素耐药性，全球公共卫生威胁。登革热的非特异性表现，本身对公众健康的威胁越来越大，导致可避免的经验性抗生素处方，特别是在儿童中。在一项基于人群的全国综合横断面研究中，我们评估了台湾确诊登革热病例中与抗生素处方相关的儿童和医师特征.
方法：将2008年至2015年的国家医疗保险索赔和确诊登革热病例报告联系起来，共有7086名确诊登革热儿童，门诊就诊21,744次，住院2520次。在确认日期之前或之后的一周，我们分别评估了门诊和住院环境中抗生素处方的存在。应用具有广义估计方程的Logistic回归模型来识别患者，从业者，以及与抗生素处方相关的其他因素。
结果：29.4%的18岁以下登革热患儿在14天的评估期内没有合并细菌感染。在门诊和住院环境中，抗生素处方从13.5%降至6.3%，从43.2%降至19.3%，分别,登革热确诊后。幼儿更有可能接受抗生素治疗。仅在门诊环境中观察到医生之间抗生素处方的显着差异：年龄≥60岁的医生以及在诊所和非城市机构执业的医生更有可能开抗生素处方。与其他年份相比，在特殊的2年流行期间服用抗生素的可能性较小。
结论：登革热抗生素处方，影响全球一半人口的虫媒病毒感染，显示发生在台湾29％的儿科病例中。可以通过改善抗生素管理来减少潜在可避免的抗生素消费，了解抗生素的处方条件和病毒性疾病预防策略的可用性，包括登革热。我们在这项基于人群的全国研究中确定了许多这样的因素。
方法：将2008年至2015年的国家医疗保险索赔和确诊登革热病例报告联系起来，共有7086名确诊登革热儿童，门诊就诊21,744次，住院2520次。在确认日期之前或之后的一周，我们分别评估了门诊和住院环境中抗生素处方的存在。应用具有广义估计方程的Logistic回归模型来识别患者，从业者，以及与抗生素处方相关的其他因素。
结果：29.4%的18岁以下登革热患儿在14天的评估期内没有合并细菌感染。在门诊和住院环境中，抗生素处方从13.5%降至6.3%，从43.2%降至19.3%，分别,登革热确诊后。幼儿更有可能接受抗生素治疗。仅在门诊环境中观察到医生之间抗生素处方的显着差异：年龄≥60岁的医生以及在诊所和非城市机构执业的医生更有可能开抗生素处方。与其他年份相比，在特殊的2年流行期间服用抗生素的可能性较小。
结论：登革热抗生素处方，影响全球一半人口的虫媒病毒感染，显示发生在台湾29％的儿科病例中。可以通过改善抗生素管理来减少潜在可避免的抗生素消费，了解抗生素的处方条件和病毒性疾病预防策略的可用性，包括登革热。我们在这项基于人群的全国研究中确定了许多这样的因素。
