UNASSIGNED:由于越来越多的证据表明,静脉(IV)头孢唑啉早期改用口服头孢氨苄对儿童无并发症的小儿骨髓炎(OM)和化脓性关节炎(SA)的疗效,我们改变了在这些情况下经验性抗生素治疗的指南.本研究旨在评估指南实施对减少广谱抗生素处方的影响,静脉注射抗生素治疗的持续时间和住院时间,治疗失败和复发。
未经评估:这是一个回顾展,观察,准实验研究。将干预前的四年与六年进行比较,干预后10个月(2012年1月至2015年12月;2016年1月至10月31日,2022年)。对所有年龄3个月至18岁的OM或SA患者进行纳入评估。每个人群分为三组:干预前,干预后不遵循指导方针,以及遵循指南的干预后。抗生素处方的差异,如治疗天数(DOT),活动谱和治疗长度(LOT),住院时间(LOS),广谱抗生素持续时间(bsDOT),治疗失败和6个月时复发作为结局分析.
未经证实:在87名纳入的患者中,48例诊断为OM(8例干预前,9个未遵循指南的干预后,31个遵循指南的干预后)和39个使用SA(9个干预前,12个干预后未遵循指南,18个干预后遵循指南)。在OM患者中,IVDOT,DOT/LOT比值,指南组的bsDOT明显较低,IV治疗出院的患者比例也最低。值得注意的是,干预后治疗组需要手术的病例明显减少.考虑到SA,LOS,IVDOT,DOT/LOT比值,和bsDOT在指南组中显著较低。OM和SA的治疗失败率在所有组之间是相当的。没有复发病例。总体依从性在72和100%之间。
UASSIGNED:指南的实施有效地减少了广谱抗生素和联合治疗对OM和SA的广泛使用。我们的结果表明了其适用性,安全,使用头孢唑啉的窄谱IV经验性抗生素方案的疗效,然后口服第一代/第二代头孢菌素的单一疗法,这不劣于广谱疗法。
UNASSIGNED: Due to the growing evidence of the efficacy of intravenous (IV) cefazolin with an early switch to oral cefalexin in uncomplicated pediatric
osteomyelitis (OM) and septic arthritis (SA) in children, we changed our
guidelines for empiric antibiotic therapy in these conditions. This study aims at evaluating the impact of the
guidelines\' implementation in reducing broad-spectrum antibiotic prescriptions, duration of IV antibiotic treatment and hospital stay, treatment failure and recurrence.
UNASSIGNED: This is a retrospective, observational, quasi-experimental study. The four years pre-intervention were compared to the six years, ten months post-intervention (January 2012, through December 2015; January 2016, through October 31st, 2022). All patients aged 3 months to 18 years with OM or SA were evaluated for inclusion. Each population was divided into three groups: pre-intervention, post-intervention not following the guidelines, and post-intervention following the
guidelines. Differences in antibiotic prescriptions such as Days of Therapy (DOT), activity spectrum and Length of Therapy (LOT), length of hospital stay (LOS), broad-spectrum antibiotics duration (bsDOT), treatment failure and relapse at six months were analyzed as outcomes.
UNASSIGNED: Of 87 included patients, 48 were diagnosed with OM (8 pre-intervention, 9 post-intervention not following the guidelines and 31 post-intervention following the guidelines) and 39 with SA (9 pre-intervention, 12 post-intervention not following the
guidelines and 18 post-intervention following the
guidelines). In OM patients, IV DOT, DOT/LOT ratio, and bsDOT were significantly lower in the guidelines group, with also the lowest proportion of patients discharged on IV treatment. Notably, significantly fewer cases required surgery in the post-intervention groups. Considering SA, LOS, IV DOT, DOT/LOT ratio, and bsDOT were significantly lower in the guidelines group. The treatment failure rate was comparable among all groups for both OM and SA. There were no relapse cases. The overall adherence was between 72 and 100%.
UNASSIGNED: The implementation of guidelines was effective in decreasing the extensive use of broad-spectrum antibiotics and combination therapy for both OM and SA. Our results show the applicability, safety, and efficacy of a narrow-spectrum IV empirical antibiotic regimen with cefazolin, followed by oral monotherapy with first/second-generation cephalosporins, which was non-inferior to broad-spectrum regimens.