Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study

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• 作者：Muriel Le Bourgeois ; MD¹ ; ^{muriel.lebourgeois@nck.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Agnè ; s Ferroni ; MD² ; Marianne Leruez-Ville ; MD² ; Emmanuelle Varon ; MD³ ; ⁴ ; Caroline Thumerelle ; MD⁵ ; Franç ; ois Bré ; mont ; MD ; PhD⁶ ; Michael J. Fayon ; MD ; PhD⁷ ; Christophe Delacourt ; MD ; PhD¹ ; ⁸ ; Caroline Ligier ; MPh⁹ ; ¹⁰ ; ¹¹ ; Laurence Watier ; PhD⁹ ; ¹⁰ ; ¹¹ ; Didier Guillemot ; MD ; PhD⁹ ; ¹⁰ ; ¹¹ ; ¹² ; on behalf of the Children ; Antibiotics ; Nonsteroidal Anti-inflammatory Drugs ; Childhood Empyema (ChANCE) Study Group^&lowast ; ; Jacques de Blic ; MD ; PhD ; Antoine Deschildre ; MD ; Gaë ; lle Lemanac'h ; MD ; Sté ; phanie Bui ; MD ; Christophe Marguet ; MD ; PhD ; Marc Lubrano ; MD ; André ; Labbé ; MD ; PhD ; Isabelle Petit ; MD ; Albert Faye ; MD ; PhD ; Mathie Lorrot ; MD ; Fouad Mahdi ; MD ; CHIC ; Jean-Christophe Dubus ; MD ; PhD ; Emmanuelle Bosdure ; MD ; Isabelle Pin ; MD ; Cathy Llerena ; MD ; Jocelyne Derelle ; MD ; Cyril Schweitzer ; MD ; PhD ; Ralph Epaud ; MD ; PhD ; Nadia Nathan ; MD ; Philippe Reix ; MD ; PhD ; Sté ; phanie Wanin ; MD ; Valé ; rie David ; MD ; Ulrika de Pontbriand ; MD ; Jacques Brouard ; MD ; PhD ; Aude Bessiè ; re ; MD ; Caroline Douay ; MPh ; Claire Dupont ; MPh ; Claire Petit ; MPh ; Jean-Romain Richard ; MPh ; Christine Toneatti ; MPh ; Marie-Anne Vibet ; MPh
• 关键词：children ; empyema ; NSAIDs
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：175
• 期：Complete
• 页码：47-53.e3
• 全文大小：688 K

文摘

To investigate the risk factors of empyema after acute viral infection and to clarify the hypothesized association(s) between empyema and some viruses and/or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Study design

A case-control study was conducted in 15 centers. Cases and controls were enrolled for a source population of children 3-15 years of age with acute viral infections between 2006 and 2009.

Results

Among 215 empyemas, 83 cases (children with empyema and acute viral infection within the 15 preceding days) were included, and 83 controls (children with acute viral infection) were matched to cases. Considering the intake of any drug within 72 hours after acute viral infection onset and at least 6 consecutive days of antibiotic use and at least 1 day of NSAIDs exposure, the multivariable analysis retained an increased risk of empyema associated with NSAIDs exposure (aOR 2.79, 95% CI 1.4-5.58, P = .004), and a decreased risk associated with antibiotic use (aOR 0.32, 95% CI 0.11-0.97, P = .04). The risk of empyema associated with NSAIDs exposure was greater for children not prescribed an antibiotic and antibiotic intake diminished that risk for children given NSAIDs.

Conclusions

NSAIDs use during acute viral infection is associated with an increased risk of empyema in children, and antibiotics are associated with a decreased risk. The presence of antibiotic-NSAIDs interaction with this risk is suggested. These findings suggest that NSAIDs should not be recommended as a first-line antipyretic treatment during acute viral infections in children.