背景:抗菌素耐药性(AMR)是成人和儿童的重要全球公共卫生问题。喉气管支气管炎(croup)是儿童常见的急性呼吸道感染(ARI),通常是由病毒引起的,并且不应该用抗生素治疗。使用抗菌药物管理计划(ASP)减少ARI中不必要的抗生素的使用是针对儿童AMR的有效措施。这项研究调查了韩国小儿喉气管支气管炎患者的抗生素处方模式。我们的成果将有用改良ASP。
方法:数据来自政府机构健康保险审查和评估服务。我们分析了针对≤5岁儿童的门诊处方,这些儿童的诊断代码为喉气管支气管炎,即,国际疾病分类,第十次修订,代码J050(croup),J040(喉炎),或J041(支气管炎),2017-2020年。对于每个处方,人口统计信息和有关就诊医疗机构的信息(医院类型,医生的专业,医院的位置)被提取。随后估计了总体抗生素处方率,并进行多变量分析以确定抗生素处方的相关因素。描述了处方抗生素并将其分类为超广谱青霉素,头孢菌素,和大环内酯类。
结果:在审查的2,358,194张处方中,829,172(35.2%)含有抗生素。在多变量分析中,医院的管理是与抗生素处方相关的最强因素(调整后比值比[aOR],22.33;95%置信区间[CI],20.87-23.89;P<0.001),其次是诊所的管理(AOR,12.66;95%CI,11.83-13.54;P<0.001)和综合医院的管理(aOR,8.96;95%CI,8.37-9.59;P<0.001)。抗生素处方也与≤2岁的患者显着相关,由儿科专家管理,并在非大都市地区的医院接受治疗。总的来说,广谱青霉素是最常用的(18.6%)抗生素,其次是头孢菌素类(9.4%)和大环内酯类(8.5%)。
结论:我们的研究结果表明,ASP需要关注医院的医生,诊所,综合医院,和儿科专科。向这些群体提供教育计划以提高对AMR和适当抗生素使用的认识可能是有效的ASP政策,并且可能有助于减少儿科患者中喉气管支气管炎的不必要的抗生素处方,因此可能会减少韩国儿童的AMR。
BACKGROUND: Antimicrobial resistance (AMR) is an important global public health concern in adults and children. Laryngotracheobronchitis (croup) is a common acute respiratory infection (ARI) among children, most often caused by a virus, and should not be treated with antibiotics. Reducing the usage of unnecessary antibiotics in ARI using an antimicrobial stewardship program (ASP) is an effective measure against AMR in children. This study investigates the antibiotic prescription pattern in pediatric patients with laryngotracheobronchitis in Korea. Our results will be useful to improve the ASP.
METHODS: The data were obtained from the government agency Health Insurance Review and Assessment Service. We analyzed outpatient prescriptions issued to children ≤ 5 years of age with a first-listed diagnosis code for laryngotracheobronchitis, i.e., International Classification of Disease, 10th Revision, code J050 (croup), J040 (
laryngitis), or J041 (tracheitis), during 2017-2020. For each prescription, demographic information and information about medical facilities visited (type of hospital, specialty of physician, location of hospital) were extracted. The overall antibiotic prescription rate was subsequently estimated, and multivariable analysis was conducted to determine the associated factors of antibiotic prescription. Prescribed antibiotics were described and classified into extended-spectrum penicillins, cephalosporin, and macrolides.
RESULTS: Of 2,358,194 prescriptions reviewed, 829,172 (35.2%) contained antibiotics. In the multivariable analysis, management in a hospital was the strongest factor associated with antibiotic prescription (adjusted odds ratio [aOR], 22.33; 95% confidence interval [CI], 20.87-23.89; P < 0.001), followed by management in a clinic (aOR, 12.66; 95% CI, 11.83-13.54; P < 0.001) and management in a general hospital (aOR, 8.96; 95% CI, 8.37-9.59; P < 0.001). Antibiotic prescription was also significantly associated with patients who were ≤ 2 years of age, managed by a pediatric specialist, and treated at a hospital located in a non-metropolitan region. Overall, extended-spectrum penicillins were the most frequently prescribed (18.6%) antibiotics, followed by cephalosporins (9.4%) and macrolides (8.5%).
CONCLUSIONS: The results of our study suggest that ASPs need to focus on physicians in hospitals, clinics, general hospitals, and pediatric specialties. Providing education programs to these groups to increase awareness of AMR and appropriate antibiotics use could be effective ASP policy and may help to reduce unnecessary prescriptions of antibiotics for laryngotracheobronchitis among pediatric patients and therefore potentially AMR in children in Korea.