快速流感抗原检测在儿科流感样疾病急诊室抗菌管理中的作用

Dianne Alexis Millado-Riambon, E. Gallardo, Aaron Tulay
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摘要

背景:流感是一种常见的呼吸道感染,诊断仍然是一个挑战。使用快速抗原检测可能会影响急诊室(ER)的治疗决策。目的:探讨快速流感抗原检测(RIAT)在急诊室流感样疾病(ILI)抗菌管理中的作用,确定小儿ILI患者的临床特征,并探讨RIAT检测结果与症状及免疫接种状况的关系。方法:这是一项横断面研究,回顾了2019年9月至2020年2月在某三级医院急诊室通过鼻咽拭子接受RIAT (KlintecTM)治疗的195例ILI儿童患者的图表。采用卡方检验、Fischer精确检验和似然比进行数据分析。结果:儿童患者以7 ~ 12岁男性居多。大多数患者表现为发烧、咳嗽和感冒,并在发病后2-4天接受了RIAT检查。约73.33%的研究参与者没有接种每年的流感疫苗,70.7%的RIAT阳性患者没有接种流感疫苗。与未接种疫苗的儿童相比,接种疫苗的儿童出现咳嗽(86.5%对89.5%)和感冒(80.8%对83.2%)的比例较低。RIAT结果对ILI患者抗菌药物处方管理有显著影响。结论:流感表现为非特异性症状,接种疫苗仍是预防流感的主要措施。RIAT的结果促进了流感的靶向治疗,减少了不必要的抗菌药物的使用,但这应该经过仔细的思考和解释。
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Effects of Rapid Influenza Antigen Test on Antimicrobial Management of Pediatric Patients with Influenza-Like Illness in the Emergency Room
Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER). Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status. Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis. Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI. Conclusion: Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.
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