传染性单核细胞增多症患儿使用抗菌药物与皮疹发生风险的相关性研究

Association between the use of antimicrobials and the risk of rash in children with infectious mononucleosis

目的:评价传染性单核细胞增多症(infectious mononucleosis,IM)患儿使用抗菌药物与皮疹发生风险的相关性。方法:基于贵州省人民医院电子信息病例系统开展回顾性队列研究,纳入2016年1月至2021年5月在我院(贵州省人民医院)确诊为IM且年龄小于18岁的住院患者,以是否使用抗菌药物作为暴露因素,以皮疹作为结局指标,采用χ;检验或Fisher确切概率法进行单因素分析,采用Logistic回归模型进行多因素分析。结果:共纳入436例IM患儿,有120例患儿在病程中未使用任何抗菌药物,316例在病程中至少使用过1次抗菌药物。有14例患儿使用过阿莫西林;有302例患儿使用过其他类抗菌药物。Logistic回归的结果提示,在同时控制了性别、年龄和过敏史等混杂因素的情况下,使用抗菌药物对HIS系统记录的皮疹发生风险的影响无统计学意义(AOR=0.826,95%CI:0.449~1.518,P=0.537)。单因素分析结果提示,使用其他类抗菌药物的患儿发生药物相关性皮疹的风险高于使用阿莫西林的患儿,但差异无统计学意义(13.25%vs.0.00%,P=0.230)。结论:IM患儿使用抗菌药物可能不会增加皮疹风险,而使用阿莫西林发生药物相关性皮疹的风险可能低于使用其他类抗菌药物,但该结论还有待多中心大样本的前瞻性队列研究进一步验证。

OBJECTIVE To evaluate the association between the use of antimicrobials and the risk of rash in children with infectious mononucleosis(IM).METHODS Based on the hospital information system(HIS)of Guizhou Provincial People’s Hospital,a retrospective cohort study was conducted.The inpatients with IM(age<18 years old)were included from January 2016 to May 2021.The exposure was whether the patients received antimicrobials and the outcome was the incidence of rash.The Chi-square test or Fisher’s exact test and logistic regression model were used to perform univariate analysis and multivariate analysis,respectively.RESULTS A total of 436 IM patients were included.The number of patients who did and did not receive any antimicrobials was 316 and 120,respectively.Only 14 patients were treated with amoxicillin.The logistic regression model indicated that the use of antimicrobials was not associated with the increase in risk of rash[adjusted odds ratio(AOR)=0.826,95% credible interval(CI):0.449~1.518,P=0.537]when the other confounding factors such as gender,age,and history of allergy were controlled.The univariate analysis showed that the risk of rash in patients who received other types of antimicrobials was much higher than those who received amoxicillin,while the difference was not significant(13.25%vs.0.00%,P=0.230).CONCLUSION The use of antimicrobials in IM patients may not increase the risk of rash,while the incidence of rash in IM patients with amoxicillin may be lower than those with other antimicrobials.Considering the limitations of included studies,the results should be further verified by multicenter,prospective and cohort studies with large sample size.