Evaluating prior antibiotic use as a risk factor for acute gastroenteritis among children in Davidson County, Tennessee - 2014-2015 Public
Kolsin, Jonathan (2017)
Published
Abstract
Background: Among children under 5 years of age in the U.S., acute gastroenteritis (AGE) accounts for >1.5 million outpatient visits and 200,000 hospitalizations each year. Most AGE in children is caused by viruses, with norovirus and rotavirus being the most prevalent pathogens. Despite growing biologic evidence that the intestinal microbiota is involved in norovirus and rotavirus infections, there is a lack of epidemiologic studies which evaluate the relationship between antibiotic use and AGE caused by these pathogens.
Methods: We analyzed AGE cases and healthy controls from the Vanderbilt University School of Medicine site of the New Vaccine Surveillance Network from December 1, 2014 to November 30, 2015. Four outcomes were defined: overall AGE, norovirus-associated AGE, rotavirus-associated AGE, and non-norovirus/non-rotavirus AGE. Multiple logistic regression was performed to evaluate the association between prior antibiotic use and the four AGE outcomes as well as with AGE severity.
Results: The percentage of patients with reported antibiotic use in the 3 months prior to enrollment was similar across the four AGE outcomes (overall: 21.1%, norovirus-associated: 23.4%, rotavirus-associated: 26.0%, and non-norovirus/non-rotavirus: 22.2%), and was higher than reported among healthy controls (9.4%). Compared to healthy controls, overall AGE cases were 4.1 (95% confidence interval [CI]: 1.6, 10.3) times more likely to have antibiotic use in the 3 weeks prior to enrollment and 2.7 (95% CI: 1.7, 4.3) times more likely to have antibiotic use within 3 months prior to enrollment. Similar results were found for the other specific AGE outcomes. For the overall AGE group, the odds of antibiotic use in the 3 months prior to illness onset was 4.4 (95% CI: 1.7, 3.4) times higher for inpatient compared to outpatient cases and 2.2 (95% CI: 1.5, 3.2) times higher for emergency department compared to outpatient cases.
Conclusions: Prior antibiotic use among children was associated with increased odds of AGE, irrespective of etiology, and this association was stronger for more recent antibiotic use. Prior antibiotic use was also associated with more severe AGE. These data suggest that intestinal microbiota may play a protective role in AGE among children, providing additional support for the judicious use of antibiotics.
Table of Contents
Chapter I: Literature Review………...……………1
Chapter II: Manuscript………………………...…11
Abstract………………………………….11
Introduction……………………………...12
Methods…………...…………………….14
Results…………………………………...18
Discussion……………………………….21
References……………………………….25
Tables……………………………………28
Chapter III: Public Health Implications………....31
Appendices………………………………...……….32
Appendix A………………………………32
Appendix B………………………………34
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