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JAMA子刊：儿童呼吸道感染做“呼吸道病原体即时检测”有用吗？抗生素该用还是得用！

2022-06-11 liangying MedSci原创

呼吸道病原体即时检测儿童抗生素使用
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呼吸道病原体的检测对急性疾病儿童的临床决策影响似乎很有限。

急性呼吸道感染是儿童在急诊就诊的主要原因，由于诊断的不确定性，高达70%的儿童呼吸道感染都常规接受了抗生素治疗，抗生素的使用与耐药性的增加有关，因此迫切需要新的方法来指导急性病儿童的抗生素处方。

关于多重聚合酶链反应(PCR)对急性患儿呼吸道病原体的即时检测的临床影响的现有数据有限，本研究的目的是评价多重PCR即时检测呼吸道病原体对急性呼吸道感染的患儿使用抗生素的影响。

这项非盲随机临床试验于2019年5月6日至2020年3月12日进行。对受试者进行随访直至住院或从急诊室（ED）出院以获得主要结果。这项研究是在芬兰奥鲁大学医院儿科急诊室进行的。符合条件的研究参与者为0至17岁的发烧和/或有任何呼吸道体征或症状的儿童，包括有潜在疾病的儿童。统计分析在2020年8月11日至2021年9月14日期间进行。主要结果是接受抗生素治疗的儿童比例。次要结果是诊断试验和放射成像程序的数量和成本。

共有1417名儿童接受了资格评估，最后1243名符合纳入标准的儿童（其中692名男孩[56%]）被随机分配到干预组（829名儿童）或对照组（414名儿童）。干预组参与者的平均年龄为3岁，对照组也为3岁。呼吸道病原体多重PCR定点检测并未减少急诊科抗生素的总体处方。12名接受即时多重PCR检测的儿童开始接受靶向抗生素治疗，其中对照组有2名。两组之间进行诊断测试的次数没有差异，费用也没有差异。

意向治疗人群的试验结果

总之，在这项随机临床试验中，对呼吸道病原体的即时检测并没有减少儿科急诊科抗生素的使用。呼吸道病原体的检测对急性疾病儿童的临床决策影响似乎很有限。

参考文献：Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(6):e2216162. doi:10.1001/jamanetworkopen.2022.16162

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    2022-06-12 weigq

    需要更多更大人群的研究。

    0

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    2022-06-12 zhmscau

    #呼吸道#

    0

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    2022-06-12 xue8605

    #病原体#

    0

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    2022-06-11 ms4000000034336854

    学习了

    0

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    2022-06-11 杨海东

    坚持学习

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1225944, encodeId=64a6122594458, content=需要更多更大人群的研究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Sun Jun 12 10:41:18 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282589, encodeId=2d4f12825891b, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Sun Jun 12 08:25:31 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510674, encodeId=988a15106e4c8, content=<a href='/topic/show?id=2efbe0807b1' target=_blank style='color:#2F92EE;'>#病原体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70807, encryptionId=2efbe0807b1, topicName=病原体)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f6c210226313, createdName=xue8605, createdTime=Sun Jun 12 08:25:31 CST 2022, time=2022-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225831, encodeId=4d7312258314f, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=14408199438, createdName=ms4000000034336854, createdTime=Sat Jun 11 15:54:43 CST 2022, time=2022-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225827, encodeId=f2fb122582e6b, content=坚持学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=杨海东, createdTime=Sat Jun 11 14:42:19 CST 2022, time=2022-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243555, encodeId=82f012435559d, content=JAMA上文章都是顶级的，谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Fri Jun 10 20:25:31 CST 2022, time=2022-06-10, status=1, ipAttribution=)]
    2022-06-10 肿瘤克星

    JAMA上文章都是顶级的，谢谢梅斯及时上新

    0