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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Abstract

Objective

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.

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Most cited references 37

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Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR.

M. Guiver, C Corless, Amy Jones … (2001)

A single-tube 5' nuclease multiplex PCR assay was developed on the ABI 7700 Sequence Detection System (TaqMan) for the detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae from clinical samples of cerebrospinal fluid (CSF), plasma, serum, and whole blood. Capsular transport (ctrA), capsulation (bexA), and pneumolysin (ply) gene targets specific for N. meningitidis, H. influenzae, and S. pneumoniae, respectively, were selected. Using sequence-specific fluorescent-dye-labeled probes and continuous real-time monitoring, accumulation of amplified product was measured. Sensitivity was assessed using clinical samples (CSF, serum, plasma, and whole blood) from culture-confirmed cases for the three organisms. The respective sensitivities (as percentages) for N. meningitidis, H. influenzae, and S. pneumoniae were 88.4, 100, and 91.8. The primer sets were 100% specific for the selected culture isolates. The ctrA primers amplified meningococcal serogroups A, B, C, 29E, W135, X, Y, and Z; the ply primers amplified pneumococcal serotypes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10A, 11A, 12, 14, 15B, 17F, 18C, 19, 20, 22, 23, 24, 31, and 33; and the bexA primers amplified H. influenzae types b and c. Coamplification of two target genes without a loss of sensitivity was demonstrated. The multiplex assay was then used to test a large number (n = 4,113) of culture-negative samples for the three pathogens. Cases of meningococcal, H. influenzae, and pneumococcal disease that had not previously been confirmed by culture were identified with this assay. The ctrA primer set used in the multiplex PCR was found to be more sensitive (P < 0.0001) than the ctrA primers that had been used for meningococcal PCR testing at that time.

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An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations.

Carrie L. Byington, LaShonda Y Spencer, Timothy A. Johnson … (2002)

We investigated the increasing incidence of pediatric empyema during the 1990s at Primary Children's Medical Center in Salt Lake City. Of 540 children hospitalized with community-acquired bacterial pneumonia (CAP) who were discharged from 1 July 1993 through 1 July 1999, 153 (28.3%) had empyema. The annual population incidence of empyema increased during the study period from 1 to 5 cases per 100,000 population aged 3 years old, to have > or =7 days of fever, to have varicella, and to have received antibiotics and ibuprofen before admission to the hospital, compared with patients without empyema (P<.0001 for each factor). The increasing incidence of empyema was associated with infection due to S. pneumoniae serotype 1, outpatient treatment with certain antibiotics, ibuprofen use, and varicella.

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Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection.

Jeffrey Bender, Carrie L. Byington, Xiaoming Sheng … (2008)

Our objective was to demonstrate correlations between invasive pneumococcal disease in children and circulating respiratory viruses. This retrospective study included 6 winter respiratory viral seasons (2001-2007) in Intermountain Healthcare, an integrated health system in the Intermountain West, including Primary Children's Medical Center in Salt Lake City, Utah. Children <18 years of age who were hospitalized with either invasive pneumococcal disease in any Intermountain Healthcare facility or culture-confirmed invasive pneumococcal disease at Primary Children's Medical Center were included. We analyzed the correlation between invasive pneumococcal disease and circulating respiratory viruses. A total of 435 children with invasive pneumococcal disease and 203 with culture-confirmed invasive pneumococcal disease were hospitalized in an Intermountain Healthcare facility or Primary Children's Medical Center during the study period. During the same period, 6963 children with respiratory syncytial virus, 1860 with influenza virus, 1459 with parainfluenza virus, and 818 with adenoviruses were evaluated at Primary Children's Medical Center. A total of 253 children with human metapneumovirus were identified during the last 5 months of the study. There were correlations between invasive pneumococcal disease and seasonal respiratory syncytial virus, influenza virus, and human metapneumovirus activity. The correlation with invasive pneumococcal disease was strong up to 4 weeks after respiratory syncytial virus activity. For influenza virus and human metapneumovirus, the correlations were strong at 2 weeks after activity of these viruses. Pneumonia was the most common clinical disease associated with culture-confirmed invasive pneumococcal disease, mostly attributable to serotypes 1, 19A, 3, and 7F. In the post-pneumococcal conjugate vaccine era, seasonal increases in respiratory syncytial virus, influenza virus, and human metapneumovirus infections in children were associated with increased pediatric admissions with invasive pneumococcal disease, especially pneumonia caused by nonvaccine serotypes.

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Author and article information

Contributors

Muriel Le Bourgeois

Journal

Journal ID (nlm-ta): J Pediatr

Journal ID (iso-abbrev): J. Pediatr

Title: The Journal of Pediatrics

Publisher: Mosby

ISSN (Print): 0022-3476

ISSN (Electronic): 1097-6833

Publication date PMC-release: 20 June 2016

Publication date (Print): August 2016

Publication date (Electronic): 20 June 2016

Volume: 175

Pages: 47-53.e3

Affiliations

[1 ]Department of Pediatric Pulmonology, University Hospital Necker-Enfants Malades, APHP, Paris, France

[2 ]Department of Microbiology, University Hospital Necker-Enfants Malades, APHP, Paris, France

[3 ]Department of Microbiology, European Hospital Georges-Pompidou, APHP, Paris, France

[4 ]National Reference Center for Pneumococci, APHP, Paris, France

[5 ]Department of Pediatric Pulmonology, University Hospital Jeanne de Flandre, Université Nord de France, Lille, France

[6 ]Department of Pediatric Pulmonology, University Hospital, Toulouse, France

[7 ]Department of Pediatric Pulmonology, University Hospital, CIC 1401, Bordeaux, France

[8 ]Paris Descartes University, Paris, France

[9 ]INSERM, U 1181, Paris, France

[10 ]Institut Pasteur, PhEMI, Paris, France

[11 ]Versailles -Saint -Quentin University, University of Medicine Paris Île-de-France Ouest, EA 4499, Versailles, France

[12 ]Department of Epidemiology, APHP, Raymond-Poincaré Hospital, Garches, France

Author notes

[∗ ]Reprint requests: Muriel Le Bourgeois, MD, Department of Pediatric Pulmonology, APHP, Hôpital Universitaire Necker–Enfants Malades, 149 rue de Sèvres, 75015 Paris, France. muriel.lebourgeois@ 123456nck.aphp.fr

[∗]

List of ChANCE Study Group members is available at www.jpeds.com ( Appendix).

Article

Publisher ID: S0022-3476(16)30233-5

DOI: 10.1016/j.jpeds.2016.05.025

PMC ID: 7094675

PubMed ID: 27339249

SO-VID: 369b0386-3dbe-4ea4-9321-4d87269461b3

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 14 December 2015

Date revision received : 12 April 2016

Date accepted : 9 May 2016

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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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Abstract

Objective

Study design

Results

Conclusions

Related collections

Chinese Journal of School Health

Most cited references 37

Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR.

An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations.

Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection.

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Cited by 26

Most referenced authors 370