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2. Timing and sequence of vaccination against COVID-19 and influenza (TACTIC): a single-blind, placebo-controlled randomized clinical trial

Author

Dulfer, Elisabeth A., Geckin, Büsra, Taks, Esther J.M., GeurtsvanKessel, Corine H., Dijkstra, Helga, van Emst, Liesbeth, van der Gaast – de Jongh, Christa E., van Mourik, Djenolan, Koopmans, Petra C., Domínguez-Andrés, Jorge, van Crevel, Reinout, van de Maat, Josephine S., de Jonge, Marien I., and Netea, Mihai G.

Published
2023
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3. Bacillus Calmette-Guérin vaccine for prevention of COVID-19 and other respiratory tract infections in older adults with comorbidities: a randomized controlled trial

Author

Aardenburg-van Huisstede, Astrid, Ammerlaan, Heidi S.M., Boersma, Willem G., Bonten, Marc J.M., van den Bosch, Maurice A.A.J., Brinkman, Kees, Bruijning-Verhagen, Patricia C.J., van Crevel, Reinout, Delsing, Corine, ten Doesschaten, Thijs, Dofferhoff, Anton S.M., Duijkers, Ruud, Fohse, Konstantin, Grobusch, Martin P., Groenwold, Rolf H.H., de Haas, Corine, Hassing, Robert-Jan, de Hoog, Marieke L.A., Hoogerwerf, Jacobien J., Huijts, Susanne M., van Hylckama-Vlieg, Astrid, Jong, Eefje, de Jong, Hanna K., Knap, Martijn, Koekenbier, Eva L., Koenders, Michael, Kouijzer, Ilse J.E., Kramer, Henk, van de Laar, Roel, Lalmohamed, Arief, Lensen, Karel-Jan D.F., Lijfering, Willem M., van de Maat, Josephine S., Magdelijns, Fabienne, Meek, Bob, Middelburg, Rutger A., Moeniralam, Hazra S., Mooijaart, Simon P., van Munster, Barbara C., Netea, Mihai G., van Nieuwkoop, Cees, ten Oever, Jaap, Oosterheert, Jan Jelrik, Goossens, Marc Padros, Peters, Vincent, Postma, Douwe F., Pouw, Niels, Reesink, Herre J., de Regt, Marieke J.A., van der Reijden, Anneli C.J., Rosendaal, Frits R., Schaakxs, R., Slieker, Kitty, Slingerland, Robbert J., van Sluis, Nicolette L.J., Stehouwer, Coen D.A., van de Veerdonk, Frank, Verbon, Annelies, van Werkhoven, C.H. (Henri), van de Wijgert, Janneke H.H., and Werkhoven, C.H. (Henri) van

Published
2023
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5. Timing and sequence of vaccination against COVID-19 and influenza – Author's reply

Author

Dulfer, Elisabeth A., primary, Geckin, Büsra, additional, Taks, Esther J.M., additional, GeurtsvanKessel, Corine H., additional, Dijkstra, Helga, additional, van Emst, Liesbeth, additional, van der Gaast – de Jongh, Christa E., additional, Koopmans, Petra C., additional, Domínguez-Andrés, Jorge, additional, van Crevel, Reinout, additional, van de Maat, Josephine S., additional, de Jonge, Marien I., additional, and Netea, Mihai G., additional

Published
2023
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6. Corrigendum: The impact of circadian rhythm on Bacillus Calmette-Guérin vaccination effects on SARS-CoV-2 infections

Author

Föhse, Konstantin, primary, Taks, Esther J. M., additional, Moorlag, Simone J. C. F. M., additional, Bonten, Marc J. M., additional, van Crevel, Reinout, additional, ten Oever, Jaap, additional, van Werkhoven, Cornelis H., additional, Netea, Mihai G., additional, van de Maat, Josephine S., additional, and Hoogerwerf, Jacobien J., additional

Published
2023
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7. Timing and sequence of vaccination against COVID-19 and influenza – Author's reply

Author

Dulfer, Elisabeth A., Geckin, Büsra, Taks, Esther J.M., GeurtsvanKessel, Corine H., Dijkstra, Helga, van Emst, Liesbeth, van der Gaast – de Jongh, Christa E., Koopmans, Petra C., Domínguez-Andrés, Jorge, van Crevel, Reinout, van de Maat, Josephine S., de Jonge, Marien I., Netea, Mihai G., Dulfer, Elisabeth A., Geckin, Büsra, Taks, Esther J.M., GeurtsvanKessel, Corine H., Dijkstra, Helga, van Emst, Liesbeth, van der Gaast – de Jongh, Christa E., Koopmans, Petra C., Domínguez-Andrés, Jorge, van Crevel, Reinout, van de Maat, Josephine S., de Jonge, Marien I., and Netea, Mihai G.

Published
2023

8. Bacillus Calmette-Guérin vaccine for prevention of COVID-19 and other respiratory tract infections in older adults with comorbidities:a randomized controlled trial

Author

Koekenbier, Eva L., Fohse, Konstantin, van de Maat, Josephine S., Oosterheert, Jan Jelrik, van Nieuwkoop, Cees, Hoogerwerf, Jacobien J., Grobusch, Martin P., van den Bosch, Maurice A.A.J., van de Wijgert, Janneke H.H., Netea, Mihai G., Rosendaal, Frits R., Bonten, Marc J.M., Werkhoven, C. H.(Henri) van, Koekenbier, Eva L., Fohse, Konstantin, van de Maat, Josephine S., Oosterheert, Jan Jelrik, van Nieuwkoop, Cees, Hoogerwerf, Jacobien J., Grobusch, Martin P., van den Bosch, Maurice A.A.J., van de Wijgert, Janneke H.H., Netea, Mihai G., Rosendaal, Frits R., Bonten, Marc J.M., and Werkhoven, C. H.(Henri) van

Abstract

Objectives: To test whether Bacillus Calmette-Guérin (BCG) vaccination would reduce the incidence of COVID-19 and other respiratory tract infections (RTIs) in older adults with one or more comorbidities. Methods: Community-dwelling adults aged 60 years or older with one or more underlying comorbidities and no contraindications to BCG vaccination were randomized 1:1 to BCG or placebo vaccination and followed for 6 months. The primary endpoint was a self-reported, test-confirmed COVID-19 incidence. Secondary endpoints included COVID-19 hospital admissions and clinically relevant RTIs (i.e. RTIs including but not limited to COVID-19 requiring medical intervention). COVID-19 and clinically relevant RTI episodes were adjudicated. Incidences were compared using Fine-Gray regression, accounting for competing events. Results: A total of 6112 participants with a median age of 69 years (interquartile range, 65–74) and median of 2 (interquartile range, 1–3) comorbidities were randomized to BCG (n = 3058) or placebo (n = 3054) vaccination. COVID-19 infections were reported by 129 BCG recipients compared to 115 placebo recipients [hazard ratio (HR), 1.12; 95% CI, 0.87–1.44]. COVID-19-related hospitalization occurred in 18 BCG and 21 placebo recipients (HR, 0.86; 95% CI, 0.46–1.61). During the study period, 13 BCG recipients died compared with 18 placebo recipients (HR, 0.71; 95% CI, 0.35–1.43), of which 11 deaths (35%) were COVID-19-related: six in the placebo group and five in the BCG group. Clinically relevant RTI was reported by 66 BCG and 72 placebo recipients (HR, 0.92; 95% CI, 0.66–1.28). Discussion: BCG vaccination does not protect older adults with comorbidities against COVID-19, COVID-19 hospitalization, or clinically relevant RTIs.

Published
2023

9. Timing and sequence of vaccination against COVID-19 and influenza (TACTIC):a single-blind, placebo-controlled randomized clinical trial

Author

Dulfer, Elisabeth A., Geckin, Büsra, Taks, Esther J.M., GeurtsvanKessel, Corine H., Dijkstra, Helga, van Emst, Liesbeth, van der Gaast – de Jongh, Christa E., van Mourik, Djenolan, Koopmans, Petra C., Domínguez-Andrés, Jorge, van Crevel, Reinout, van de Maat, Josephine S., de Jonge, Marien I., Netea, Mihai G., Dulfer, Elisabeth A., Geckin, Büsra, Taks, Esther J.M., GeurtsvanKessel, Corine H., Dijkstra, Helga, van Emst, Liesbeth, van der Gaast – de Jongh, Christa E., van Mourik, Djenolan, Koopmans, Petra C., Domínguez-Andrés, Jorge, van Crevel, Reinout, van de Maat, Josephine S., de Jonge, Marien I., and Netea, Mihai G.

Abstract

Background: Novel mRNA-based vaccines have been used to protect against SARS-CoV-2, especially in vulnerable populations who also receive an annual influenza vaccination. The TACTIC study investigated potential immune interference between the mRNA COVID-19 booster vaccine and the quadrivalent influenza vaccine, and determined if concurrent administration would have effects on safety or immunogenicity. Methods: TACTIC was a single-blind, placebo-controlled randomized clinical trial conducted at the Radboud University Medical Centre, the Netherlands. Individuals ≥60 years, fully vaccinated against COVID-19 were eligible for participation and randomized into one of four study groups: 1) 0.5 ml influenza vaccination Vaxigrip Tetra followed by 0.3 ml BNT162b2 COVID-19 booster vaccination 21 days later, (2) COVID-19 booster vaccination followed by influenza vaccination, (3) influenza vaccination concurrent with the COVID-19 booster vaccination, and (4) COVID-19 booster vaccination only (reference group). Primary outcome was the geometric mean concentration (GMC) of IgG against the spike (S)-protein of the SARS-CoV-2 virus, 21 days after booster vaccination. We performed a non-inferiority analysis of concurrent administration compared to booster vaccines alone with a predefined non-inferiority margin of −0.3 on the log10-scale. Findings: 154 individuals participated from October, 4, 2021, until November, 5, 2021. Anti-S IgG GMCs for the co-administration and reference group were 1684 BAU/ml and 2435 BAU/ml, respectively. Concurrent vaccination did not meet the criteria for non-inferiority (estimate −0.1791, 95% CI −0.3680 to −0.009831) and antibodies showed significantly lower neutralization capacity compared to the reference group. Reported side-effects were mild and did not differ between study groups. Interpretation: Concurrent administration of both vaccines is safe, but the quantitative and functional antibody responses were marginally lower compared to booster vac

Published
2023

10. Corrigendum: The impact of circadian rhythm on Bacillus Calmette-Guérin vaccination effects on SARS-CoV-2 infections (Front. Immunol., (2023), 14, 980711, 10.3389/fimmu.2023.980711)

Author

Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten Team 1, Föhse, Konstantin, Taks, Esther J M, Moorlag, Simone J C F M, Bonten, Marc J M, van Crevel, Reinout, Ten Oever, Jaap, van Werkhoven, Cornelis H, Netea, Mihai G, van de Maat, Josephine S, Hoogerwerf, Jacobien J, Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten Team 1, Föhse, Konstantin, Taks, Esther J M, Moorlag, Simone J C F M, Bonten, Marc J M, van Crevel, Reinout, Ten Oever, Jaap, van Werkhoven, Cornelis H, Netea, Mihai G, van de Maat, Josephine S, and Hoogerwerf, Jacobien J

Published
2023

11. The impact of circadian rhythm on Bacillus Calmette-Guérin vaccination effects on SARS-CoV-2 infections

Author

Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten Team 1, Föhse, Konstantin, Taks, Esther J M, Moorlag, Simone J C F M, Bonten, Marc J M, van Crevel, Reinout, Ten Oever, Jaap, van Werkhoven, Cornelis H, Netea, Mihai G, van de Maat, Josephine S, Hoogerwerf, Jacobien J, Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten Team 1, Föhse, Konstantin, Taks, Esther J M, Moorlag, Simone J C F M, Bonten, Marc J M, van Crevel, Reinout, Ten Oever, Jaap, van Werkhoven, Cornelis H, Netea, Mihai G, van de Maat, Josephine S, and Hoogerwerf, Jacobien J

Published
2023

12. The impact of circadian rhythm on Bacillus Calmette-Guérin vaccination effects on SARS-CoV-2 infections

Author

Föhse, Konstantin, primary, Taks, Esther J.M., additional, Moorlag, Simone J. C. F. M., additional, Bonten, Marc J. M., additional, van Crevel, Reinout, additional, ten Oever, Jaap, additional, van Werkhoven, Cornelis H., additional, Netea, Mihai G., additional, van de Maat, Josephine S., additional, and Hoogerwerf, Jacobien J., additional

Published
2023
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13. Bacillus Calmette-Guérin vaccine for prevention of COVID-19 and other respiratory tract infections in older adults with comorbidities: a randomized controlled trial

Author

Koekenbier, Eva L., primary, Fohse, Konstantin, additional, van de Maat, Josephine S., additional, Oosterheert, Jan Jelrik, additional, van Nieuwkoop, Cees, additional, Hoogerwerf, Jacobien J., additional, Grobusch, Martin P., additional, van den Bosch, Maurice A.A.J., additional, van de Wijgert, Janneke H.H., additional, Netea, Mihai G., additional, Rosendaal, Frits R., additional, Bonten, Marc J.M., additional, Werkhoven, C.H. (Henri) van, additional, Aardenburg-van Huisstede, Astrid, additional, Ammerlaan, Heidi S.M., additional, Boersma, Willem G., additional, Brinkman, Kees, additional, Bruijning-Verhagen, Patricia C.J., additional, van Crevel, Reinout, additional, Delsing, Corine, additional, ten Doesschaten, Thijs, additional, Dofferhoff, Anton S.M., additional, Duijkers, Ruud, additional, Groenwold, Rolf H.H., additional, de Haas, Corine, additional, Hassing, Robert-Jan, additional, de Hoog, Marieke L.A., additional, Huijts, Susanne M., additional, van Hylckama-Vlieg, Astrid, additional, Jong, Eefje, additional, de Jong, Hanna K., additional, Knap, Martijn, additional, Koekenbier, Eva L., additional, Koenders, Michael, additional, Kouijzer, Ilse J.E., additional, Kramer, Henk, additional, van de Laar, Roel, additional, Lalmohamed, Arief, additional, Lensen, Karel-Jan D.F., additional, Lijfering, Willem M., additional, Magdelijns, Fabienne, additional, Meek, Bob, additional, Middelburg, Rutger A., additional, Moeniralam, Hazra S., additional, Mooijaart, Simon P., additional, van Munster, Barbara C., additional, ten Oever, Jaap, additional, Goossens, Marc Padros, additional, Peters, Vincent, additional, Postma, Douwe F., additional, Pouw, Niels, additional, Reesink, Herre J., additional, de Regt, Marieke J.A., additional, van der Reijden, Anneli C.J., additional, Schaakxs, R., additional, Slieker, Kitty, additional, Slingerland, Robbert J., additional, van Sluis, Nicolette L.J., additional, Stehouwer, Coen D.A., additional, van de Veerdonk, Frank, additional, Verbon, Annelies, additional, and van Werkhoven, C.H. (Henri), additional

Published
2023
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14. The impact of circadian rhythm on Bacillus Calmette-Gue'rin vaccination effects on SARSCoV-2 infections.

Author

Föhse, Konstantin, Taks, Esther J. M., Moorlag, Simone J. C. F. M., Bonten, Marc J. M., van Crevel, Reinout, Oever, Jaap ten, van Werkhoven, Cornelis H., Netea, Mihai G., van de Maat, Josephine S., and Hoogerwerf, Jacobien J.

Subjects
CIRCADIAN rhythms, BACILLUS (Bacteria), BCG vaccines, RESPIRATORY infections, VACCINATION
Abstract

Background and objective: A recent study has suggested that circadian rhythm has an important impact on the immunological effects induced by Bacillus Calmette-Gue'rin (BCG) vaccination. The objective of this study was to evaluate whether the timing of BCG vaccination (morning or afternoon) affects its impact on severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infections and clinically relevant respiratory tract infections (RTIs). Methods: This is a post-hoc analysis of the BCG-CORONA-ELDERLY (NCT04417335) multicenter, placebo-controlled trial, in which participants aged 60 years and older were randomly assigned to vaccination with BCG or placebo, and followed for 12 months. The primary endpoint was the cumulative incidence of SARS-CoV-2 infection. To assess the impact of circadian rhythm on the BCG effects, participants were divided into four groups: vaccinated with either BCG or placebo in the morning (between 9:00h and 11:30h) or in the afternoon (between 14:30h and 18:00h). Results: The subdistribution hazard ratio of SARS-CoV-2 infection in the first six months after vaccination was 2.394 (95% confidence interval [CI], 0.856-6.696) for the morning BCG group and 0.284 (95% CI, 0.055-1.480) for the afternoon BCG group. When comparing those two groups, the interaction hazard ratio was 8.966 (95% CI, 1.366-58.836). In the period from six months until 12 months after vaccination cumulative incidences of SARS-CoV-2 infection were comparable, as well as cumulative incidences of clinically relevant RTI in both periods. Conclusion: Although there was a difference in effect between morning and afternoon BCG vaccination, the vaccine did not protect against SARS-COV-2 infections and clinically relevant RTI's at either timepoint. [ABSTRACT FROM AUTHOR]

Published
2023
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15. Thoraxfoto draagt niet bij aan besluit over antibiotica bij kinderen met een luchtweginfectie op de SEH

Author

Garcia Pérez, Daniella P., van de Maat, Josephine S., Oostenbrink, Rianne, and Pediatrics

Abstract

The chest x-ray (CXR) was the gold standard in the diagnosis of pneumonia in children. However, CXR has limitations and cannot discriminate in etiology. Current guidelines recommend against routine use of CXR in children with uncomplicated lower respiratory tract infections (LRTI). We used routine care data from a multicentre RCT including 597 children with LRTI symptoms, to evaluate the influence of CXR on antibiotic prescription in the emergency department (ED). CXR remains frequently performed in non-complex children suspected of LRTI in the ED (18%). Children who underwent CXR were more likely to receive antibiotics, even when adjusted for symptoms, hospital and CXR results. Our study highlights the inferior role of CXR in treatment decisions for children with LRTI as CXR, regardless of its results, is independently associated with more antibiotic prescriptions.

Published
2022

16. The impact of BNT162b2 mRNA vaccine on adaptive and innate immune responses

Author

Föhse, Konstantin, primary, Geckin, Büsra, additional, Zoodsma, Martijn, additional, Kilic, Gizem, additional, Liu, Zhaoli, additional, Röring, Rutger J., additional, Overheul, Gijs J., additional, van de Maat, Josephine S., additional, Bulut, Ozlem, additional, Hoogerwerf, Jacobien J., additional, Oever, Jaap ten, additional, Simonetti, Elles, additional, Schaal, Heiner, additional, Adams, Ortwin, additional, Müller, Lisa, additional, Ostermann, Philipp Niklas, additional, van de Veerdonk, Frank L., additional, Joosten, Leo A.B., additional, Haagmans, Bart L., additional, van Crevel, Reinout, additional, van Rij, Ronald P., additional, GeurtsvanKessel, Corine, additional, de Jonge, Marien I., additional, Li, Yang, additional, Domínguez-Andrés, Jorge, additional, and Netea, Mihai G., additional

Published
2021
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17. Risk factors for in-hospital mortality in laboratory-confirmed COVID-19 patients in the Netherlands: A competing risk survival analysis

Author

Nijman, Gerine, primary, Wientjes, Maike, additional, Ramjith, Jordache, additional, Janssen, Nico, additional, Hoogerwerf, Jacobien, additional, Abbink, Evertine, additional, Blaauw, Marc, additional, Dofferhoff, Ton, additional, van Apeldoorn, Marjan, additional, Veerman, Karin, additional, de Mast, Quirijn, additional, ten Oever, Jaap, additional, Hoefsloot, Wouter, additional, Reijers, Monique H., additional, van Crevel, Reinout, additional, and van de Maat, Josephine S., additional

Published
2021
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18. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands

Author

Karami, Zara, primary, Knoop, Bram T., additional, Dofferhoff, Anton S. M., additional, Blaauw, Marc J. T., additional, Janssen, Nico A., additional, van Apeldoorn, Marjan, additional, Kerckhoffs, Angèle P. M., additional, van de Maat, Josephine S., additional, Hoogerwerf, Jacobien J., additional, and ten Oever, Jaap, additional

Published
2020
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19. Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial

Author

van de Maat, Josephine S., primary, Peeters, Daphne, additional, Nieboer, Daan, additional, van Wermeskerken, Anne-Marie, additional, Smit, Frank J., additional, Noordzij, Jeroen G., additional, Tramper-Stranders, Gerdien, additional, Driessen, Gertjan J. A., additional, Obihara, Charlie C., additional, Punt, Jeanine, additional, van der Lei, Johan, additional, Polinder, Suzanne, additional, Moll, Henriette A., additional, and Oostenbrink, Rianne, additional

Published
2020
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20. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands.

Author

Karami, Zara, Knoop, Bram T., Dofferhoff, Anton S. M., Blaauw, Marc J. T., Janssen, Nico A., van Apeldoorn, Marjan, Kerckhoffs, Angèle P. M., van de Maat, Josephine S., Hoogerwerf, Jacobien J., and ten Oever, Jaap

Subjects
COVID-19, HOSPITAL patients, COVID-19 pandemic, ANTIBIOTIC overuse, MIXED infections
Abstract

Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19. We performed a retrospective observational study in four hospitals (1 university, 2 non-university teaching, 1 non-teaching hospital) in the Netherlands from March to May 2020 including consecutive patients with PCR-confirmed COVID-19. Data on first microbiological investigations obtained at the discretion of the physician and antibiotic use in the first week of hospital admission were collected. Twelve (1.2%) of the 925 patients included had a documented bacterial co-infection (75.0% pneumonia) within the first week. Microbiological testing was performed in 749 (81%) patients: sputum cultures in 105 (11.4%), blood cultures in 711 (76.9%), pneumococcal urinary antigen testing in 202 (21.8%), and Legionella urinary antigen testing in 199 (21.5%) patients, with clear variation between hospitals. On presentation 556 (60.1%; range 33.3–73.4%) patients received antibiotics for a median duration of 2 days (IQR 1–4). Intravenous to oral switch was performed in 41 of 413 (9.9%) patients who received intravenous treatment >48 h. Mean adherence to the local guideline on empiric antibiotic therapy on day 1 was on average 60.3% (range 45.3%–74.7%). On presentation to the hospital bacterial co-infections are rare, while empiric antibiotic use is abundant. This implies that in patients with COVID-19 empiric antibiotic should be withheld. This has the potential to dramatically reduce the current overuse of antibiotics in the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Published
2021
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23. Timing and sequence of vaccination against COVID-19 and influenza - Author's reply.

Author

Dulfer EA, Geckin B, Taks EJM, GeurtsvanKessel CH, Dijkstra H, van Emst L, van der Gaast-de Jongh CE, Koopmans PC, Domínguez-Andrés J, van Crevel R, van de Maat JS, de Jonge MI, and Netea MG

Abstract

Competing Interests: MGN is a scientific founder of TTxD, Lemba and BioTrip, and a member of the TTxD scientific advisory board. MGN has received research grants from TTxD and GSK. The TACTIC trial was conducted with the ZonMw COVID-19 programme. The other authors have no conflict of interest.

Published
2023
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24. [Chest x-rays do not aid in antibiotic treatment decisions for children with lower respiratory infections in the Emergency Department].

Author

Garcia Pérez DP, van de Maat JS, and Oostenbrink R

Subjects
Anti-Bacterial Agents therapeutic use, Child, Emergency Service, Hospital, Humans, X-Rays, Pneumonia diagnostic imaging, Pneumonia drug therapy, Respiratory Tract Infections diagnostic imaging, Respiratory Tract Infections drug therapy
Abstract

The chest x-ray (CXR) was the gold standard in the diagnosis of pneumonia in children. However, CXR has limitations and cannot discriminate in etiology. Current guidelines recommend against routine use of CXR in children with uncomplicated lower respiratory tract infections (LRTI). We used routine care data from a multicentre RCT including 597 children with LRTI symptoms, to evaluate the influence of CXR on antibiotic prescription in the emergency department (ED). CXR remains frequently performed in non-complex children suspected of LRTI in the ED (18%). Children who underwent CXR were more likely to receive antibiotics, even when adjusted for symptoms, hospital and CXR results. Our study highlights the inferior role of CXR in treatment decisions for children with LRTI as CXR, regardless of its results, is independently associated with more antibiotic prescriptions.

Published
2022

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