Abstract：
OBJECTIVE: Cervicofacial lymphadenitis caused by non-tubercular mycobacterial (NTM) infections has the highest infection rate in children. Our objective was to assess patient demographics, treatment methods, and the impact of weather and geography on the incidence of disease in patients with NTM cervicofacial lymphadenitis.
METHODS: The Pediatric Health Information System (PHIS) database was queried for data on all patients diagnosed with concurrent cervicofacial lymphadenopathy and NTM infection from 2004 to 2022. We assessed the association between weather patterns and NTM cervicofacial lymphadenitis by collecting monthly weather data from the NOAA National Center for Environmental Information. Incidence rates were calculated by dividing the number of cases by the total hospital discharges during the study period.
RESULTS: Among 47 PHIS hospitals, there were 992 diagnoses of NTM cervicofacial lymphadenitis. The average age at diagnosis was 2 [IQR, 2-4], with 59 % female. Drainage of skin abscesses or lesions was performed for 93 (9.4 %) patients, while 15 (1.5 %) had an excisional procedure of the CPT codes assessed. The most common antibiotics utilized were cephalosporins (28 %), macrolides (27 %), and rifampin (12 %). The most common treatment method was surgery with antibiotics (37 %) followed by no treatment at all (35 %), surgery alone (17 %), and antibiotics alone (10 %). Of the 28 states included in the analysis, Washington (IR: 3.5) and Nebraska (IR: 3.3) had the highest incidence rates (IR) of NTM cervical lymphadenitis. The cases were relatively equally distributed across the different weather seasons within each U.S. geographic region. However, the overall average wind speed was weakly associated with increasing the risk of diagnosis when utilizing a mixed effect zero-inflated negative binomial model (Incidence Ratio: 1.07, 95 % CI: (1.01-1.14), p = 0.035).
CONCLUSIONS: Our results indicate that the most common treatment method utilized in patients within our cohort with NTM cervicofacial lymphadenitis was the concurrent use of surgery and antibiotics. Our results also indicate there may be variation in the incidence rate among different states, but additional studies are needed as our cohort only included approximately 50 % of states within the U.S.
METHODS: The Pediatric Health Information System (PHIS) database was queried for data on all patients diagnosed with concurrent cervicofacial lymphadenopathy and NTM infection from 2004 to 2022. We assessed the association between weather patterns and NTM cervicofacial lymphadenitis by collecting monthly weather data from the NOAA National Center for Environmental Information. Incidence rates were calculated by dividing the number of cases by the total hospital discharges during the study period.
RESULTS: Among 47 PHIS hospitals, there were 992 diagnoses of NTM cervicofacial lymphadenitis. The average age at diagnosis was 2 [IQR, 2-4], with 59 % female. Drainage of skin abscesses or lesions was performed for 93 (9.4 %) patients, while 15 (1.5 %) had an excisional procedure of the CPT codes assessed. The most common antibiotics utilized were cephalosporins (28 %), macrolides (27 %), and rifampin (12 %). The most common treatment method was surgery with antibiotics (37 %) followed by no treatment at all (35 %), surgery alone (17 %), and antibiotics alone (10 %). Of the 28 states included in the analysis, Washington (IR: 3.5) and Nebraska (IR: 3.3) had the highest incidence rates (IR) of NTM cervical lymphadenitis. The cases were relatively equally distributed across the different weather seasons within each U.S. geographic region. However, the overall average wind speed was weakly associated with increasing the risk of diagnosis when utilizing a mixed effect zero-inflated negative binomial model (Incidence Ratio: 1.07, 95 % CI: (1.01-1.14), p = 0.035).
CONCLUSIONS: Our results indicate that the most common treatment method utilized in patients within our cohort with NTM cervicofacial lymphadenitis was the concurrent use of surgery and antibiotics. Our results also indicate there may be variation in the incidence rate among different states, but additional studies are needed as our cohort only included approximately 50 % of states within the U.S.
摘要：
目的：非结核分枝杆菌（NTM）感染引起的颈面部淋巴结炎在儿童中感染率最高。我们的目标是评估患者的人口统计学，治疗方法,以及天气和地理对NTM颈面部淋巴结炎患者疾病发生率的影响。
方法：查询儿科健康信息系统（PHIS）数据库，以获取2004年至2022年诊断为并发颈面部淋巴结肿大和NTM感染的所有患者的数据。我们通过从NOAA国家环境信息中心收集每月的天气数据来评估天气模式与NTM颈面部淋巴结炎之间的关联。通过将病例数除以研究期间的总出院率来计算发病率。
结果：在47家PHIS医院中，有992例诊断为NTM颈面部淋巴结炎。诊断时的平均年龄为2[IQR，2-4],59%是女性。93例（9.4％）患者进行皮肤脓肿或病变引流，而15人(1.5%)接受了CPT代码评估的切除程序。最常用的抗生素是头孢菌素（28％），大环内酯类（27%），和利福平(12%)。最常见的治疗方法是使用抗生素进行手术（37％），然后根本没有治疗（35％）。仅手术（17%），和单独的抗生素（10％）。在分析中包括的28个州中，华盛顿（IR：3.5）和内布拉斯加州（IR：3.3）的NTM颈淋巴结炎发病率（IR）最高。这些病例在美国每个地理区域的不同天气季节分布相对均等。然而,使用混合效应零膨胀负二项模型时，总体平均风速与诊断风险的增加弱相关(发生率：1.07，95%CI：(1.01-1.14)，p=0.035)。
结论：我们的结果表明，在我们的NTM颈面部淋巴结炎患者队列中，最常用的治疗方法是同时使用手术和抗生素。我们的结果还表明，不同州之间的发病率可能存在差异，但需要更多的研究，因为我们的队列仅包括美国约50％的州
方法：查询儿科健康信息系统（PHIS）数据库，以获取2004年至2022年诊断为并发颈面部淋巴结肿大和NTM感染的所有患者的数据。我们通过从NOAA国家环境信息中心收集每月的天气数据来评估天气模式与NTM颈面部淋巴结炎之间的关联。通过将病例数除以研究期间的总出院率来计算发病率。
结果：在47家PHIS医院中，有992例诊断为NTM颈面部淋巴结炎。诊断时的平均年龄为2[IQR，2-4],59%是女性。93例（9.4％）患者进行皮肤脓肿或病变引流，而15人(1.5%)接受了CPT代码评估的切除程序。最常用的抗生素是头孢菌素（28％），大环内酯类（27%），和利福平(12%)。最常见的治疗方法是使用抗生素进行手术（37％），然后根本没有治疗（35％）。仅手术（17%），和单独的抗生素（10％）。在分析中包括的28个州中，华盛顿（IR：3.5）和内布拉斯加州（IR：3.3）的NTM颈淋巴结炎发病率（IR）最高。这些病例在美国每个地理区域的不同天气季节分布相对均等。然而,使用混合效应零膨胀负二项模型时，总体平均风速与诊断风险的增加弱相关(发生率：1.07，95%CI：(1.01-1.14)，p=0.035)。
结论：我们的结果表明，在我们的NTM颈面部淋巴结炎患者队列中，最常用的治疗方法是同时使用手术和抗生素。我们的结果还表明，不同州之间的发病率可能存在差异，但需要更多的研究，因为我们的队列仅包括美国约50％的州
