Antibiotic misuse in respiratory tract infections in children and adults-a prospective, multicentre study (TAILORED Treatment).

Autor: van Houten CB; Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, P.O. Box 85090, Office KC.03.063.0, 3508 AB, Utrecht, The Netherlands., Cohen A; MeMed, Tirat Carmel, Israel., Engelhard D; Division of Paediatric Infectious Disease Unit, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel., Hays JP; Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands., Karlsson R; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Moore E; Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Fernández D; Noray Bioinformatics, Derio, Spain., Kreisberg R; IBEXperts Ltd, Ra'anana, Israel., Collins LV; IBEXperts Ltd, Ra'anana, Israel., de Waal W; Department of Paediatrics, Diakonessenhuis, Utrecht, The Netherlands., de Winter-de Groot KM; Department of Paediatric Respiratory Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands., Wolfs TFW; Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, P.O. Box 85090, Office KC.03.063.0, 3508 AB, Utrecht, The Netherlands., Meijers P; Department of Paediatrics, Gelderse Vallei Hospital, Ede, The Netherlands., Luijk B; Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands., Oosterheert JJ; Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands., Heijligenberg R; Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands., Sankatsing SUC; Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands., Bossink AWJ; Department of Respiratory Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands., Stubbs A; Department of Bioinformatics, Erasmus University Medical Centre, Rotterdam, The Netherlands., Stein M; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Reisfeld S; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Klein A; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Rachmilevitch R; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Ashkar J; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Braverman I; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Kartun V; Department of Paediatrics, Hillel Yaffe Medical Centre, Hadera, Israel., Chistyakov I; Department of Paediatrics, Bnai Zion Medical Centre, Haifa, Israel., Bamberger E; Department of Paediatrics, Bnai Zion Medical Centre, Haifa, Israel., Srugo I; Department of Paediatrics, Bnai Zion Medical Centre, Haifa, Israel., Odeh M; Department of Paediatrics, Bnai Zion Medical Centre, Haifa, Israel., Schiff E; Department of Paediatrics, Bnai Zion Medical Centre, Haifa, Israel., Dotan Y; Department of Internal Medicine, Bnai Zion Medical Centre, Haifa, Israel., Boico O; MeMed, Tirat Carmel, Israel., Navon R; MeMed, Tirat Carmel, Israel., Friedman T; MeMed, Tirat Carmel, Israel., Etshtein L; MeMed, Tirat Carmel, Israel., Paz M; MeMed, Tirat Carmel, Israel., Gottlieb TM; MeMed, Tirat Carmel, Israel., Pri-Or E; MeMed, Tirat Carmel, Israel., Kronenfeld G; MeMed, Tirat Carmel, Israel., Simon E; MeMed, Tirat Carmel, Israel., Oved K; MeMed, Tirat Carmel, Israel., Eden E; MeMed, Tirat Carmel, Israel., Bont LJ; Division of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, P.O. Box 85090, Office KC.03.063.0, 3508 AB, Utrecht, The Netherlands. l.bont@umcutrecht.nl.
Jazyk: angličtina
Zdroj: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology [Eur J Clin Microbiol Infect Dis] 2019 Mar; Vol. 38 (3), pp. 505-514. Date of Electronic Publication: 2019 Feb 01.
DOI: 10.1007/s10096-018-03454-2
Abstrakt: Respiratory tract infections (RTI) are more commonly caused by viral pathogens in children than in adults. Surprisingly, little is known about antibiotic use in children as compared to adults with RTI. This prospective study aimed to determine antibiotic misuse in children and adults with RTI, using an expert panel reference standard, in order to prioritise the target age population for antibiotic stewardship interventions. We recruited children and adults who presented at the emergency department or were hospitalised with clinical presentation of RTI in The Netherlands and Israel. A panel of three experienced physicians adjudicated a reference standard diagnosis (i.e. bacterial or viral infection) for all the patients using all available clinical and laboratory information, including a 28-day follow-up assessment. The cohort included 284 children and 232 adults with RTI (median age, 1.3 years and 64.5 years, respectively). The proportion of viral infections was larger in children than in adults (209(74%) versus 89(38%), p < 0.001). In case of viral RTI, antibiotics were prescribed (i.e. overuse) less frequently in children than in adults (77/209 (37%) versus 74/89 (83%), p < 0.001). One (1%) child and three (2%) adults with bacterial infection were not treated with antibiotics (i.e. underuse); all were mild cases. This international, prospective study confirms major antibiotic overuse in patients with RTI. Viral infection is more common in children, but antibiotic overuse is more frequent in adults with viral RTI. Together, these findings support the need for effective interventions to decrease antibiotic overuse in RTI patients of all ages.
Databáze: MEDLINE
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