Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study - 26/07/16

Doi : 10.1016/j.jpeds.2016.05.025

Muriel Le Bourgeois, MD ^1,^⁎ , Agnès Ferroni, MD ², Marianne Leruez-Ville, MD ², Emmanuelle Varon, MD ^3,⁴, Caroline Thumerelle, MD ⁵, François Brémont, MD, PhD ⁶, Michael J. Fayon, MD, PhD ⁷, Christophe Delacourt, MD, PhD ^1,⁸, Caroline Ligier, MPh ^9,^10,¹¹, Laurence Watier, PhD ^9,^10,¹¹, Didier Guillemot, MD, PhD ^9,^10,^11,¹²
on behalf of the
Children, Antibiotics, Nonsteroidal Anti-inflammatory Drugs and Childhood Empyema (ChANCE) Study Group^{^∗}
List of ChANCE Study Group members is available at www.jpeds.com (Appendix).
Jacques de Blic, MD, PhD, Antoine Deschildre, MD, Gaëlle Lemanac'h, MD, Stéphanie 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, Stéphanie Wanin, MD, Valérie David, MD, Ulrika de Pontbriand, MD, Jacques Brouard, MD, PhD, Aude Bessière, MD, Caroline Douay, MPh, Claire Dupont, MPh, Claire Petit, MPh, Jean-Romain Richard, MPh, Christine Toneatti, MPh, Marie-Anne Vibet, MPh

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

^∗Reprint requests: Muriel Le Bourgeois, MD, Department of Pediatric Pulmonology, APHP, Hôpital Universitaire Necker–Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.Department of Pediatric PulmonologyAPHPHôpital Universitaire Necker–Enfants Malades149 rue de SèvresParis75015France

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.

Le texte complet de cet article est disponible en PDF.

Keywords : children, empyema, NSAIDs

Abbreviations : LRTVI, NRCP, NSAID, PCR, PCV-7

Plan

Supported by the French National Clinical Research Program (AOM05103), DRRC Île-de-France, Assistance Publique–Hôpitaux de Paris and the French Agency of Health Products (2010-31), and the Agence Nationale de la Recherche, Labex Integrative Biology of Emerging Infectious Diseases (ANR-10-LABX-62-IBEID). The authors declare no conflicts of interest.

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Vol 175

P. 47 - août 2016 Retour au numéro

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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 - 26/07/16

Abstract

Objective

Study design

Results

Conclusions

Plan

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