儿童急性传染性结膜炎的病因和治疗效果。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2024-10-18 DOI:10.1016/j.jpeds.2024.114368

Holly M. Frost MD , Timothy C. Jenkins MD , Jennifer C. Meece PhD , Connie Savor-Price MD , Michael L. Wilson MD , Amy Keith MPH , Amy Stein PhD , Theresa Morin MA , Shaun Cosgrove MS , Melanie Kiernan BS , Thresia Sebastian MD , Samuel R. Dominguez MD

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引用次数: 0

摘要

研究目的研究设计：这项多中心病例对照研究共招募了 390 名儿童（194 例病例和 196 例对照），对他们的结膜样本进行了细菌和病毒病原体检测。护理人员填写了跟踪症状、抗生素使用、学校出勤率和不良事件的调查表。分析的结果包括病例与对照组通过 PCR 检测到的微生物流行率、症状、第 5 天症状缓解率、学校/托儿所出勤率以及家长报告的与抗生素相关的不良事件：大多数病例（148 例，76%）和对照组（112 例，57%）都发现了细菌，但只有流感嗜血杆菌的检测与结膜炎有关（aOR 4.59，95% CI 2.86，7.37）。脓性分泌物与流感嗜血杆菌有关（aOR 2.47，95% CI 1.23，5.01），在检测到流感嗜血杆菌的 92 例（77%）和未检测到流感嗜血杆菌的 39 例（53%）中都出现了脓性分泌物。大多数患儿的病情在第 5 天时得到了改善（186 例，96%）和缓解（166 例，86%），并且没有因眼科抗生素的使用而出现差异。护理人员报告说，21 名儿童（20%）出现了与抗生素相关的不良反应，其中 8 名儿童（8%）需要就医：结论：只有流感嗜血杆菌与结膜炎密切相关。只有流感嗜血杆菌与结膜炎有明显关联，PCR 检测到细菌或未检测到细菌的儿童症状没有差异。与抗生素的使用无关，大多数患儿的症状在第 5 天得到缓解，但在接受局部抗生素治疗的患儿中，有 20% 的患儿家长报告了不良反应，这突出表明了审慎用药的重要性。

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Etiology and Outcomes of Acute Infectious Conjunctivitis in Children

Objective

To determine the causes of conjunctivitis and whether clinical presentations and outcomes differ by pathogen.

Study design

This multicenter, case-control study enrolled 390 children (194 cases, 196 controls) whose conjunctival samples were tested for bacterial and viral pathogens. Caregivers completed surveys tracking symptoms, antibiotic use, school attendance, and adverse events. The outcomes analyzed included the prevalence of microorganisms detected by polymerase chain reaction in cases vs controls, symptoms, rate of resolution by day 5, school/childcare attendance, and parent-reported antibiotic-related adverse incidents.

Results

Most cases (148, 76%) and controls (112, 57%) had bacteria identified, although only detection of Haemophilus influenzae was associated with conjunctivitis (aOR 4.59, 95% CI 2.86, 7.37). Purulent discharge was associated with H influenzae (aOR 2.47, 95% CI 1.23, 5.01) and occurred in 92 (77%) cases in which H influenzae was detected and 39 (53%) in which H influenzae was not detected. Improvement (186, 96%) and resolution (166, 86%) were observed by day 5 for most children and did not differ on the basis of ophthalmic antibiotic use. Caregivers reported antibiotic-associated adverse events for 21 (20%) children, with 8 (8%) requiring a medical visit.

Conclusions

Only H influenzae was significantly associated with conjunctivitis. Symptoms did not differ in children with or without bacteria detected by polymerase chain reaction. Independent of antibiotic use, most children experienced resolution by day 5, but parents reported adverse events in 20% of children treated with topical antibiotics, underscoring the importance of judicious prescribing.

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来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.