Graff Gavin R, Burns Jane L
Department of Child Health, University of Missouri-Columbia, Columbia, MO 65212, USA.
Chest. 2002 Jun;121(6):1754-60. doi: 10.1378/chest.121.6.1754.
To identify factors predisposing cystic fibrosis (CF) patients to Stenotrophomonas maltophilia infection and to determine whether coinfection with S maltophilia affects the clinical response to therapy with tobramycin solution for inhalation (TSI), 300 mg bid.
Retrospective review of data collected from two identical, 6-month, randomized, placebo-controlled trials.
Sixty-nine CF centers in the United States.
Active drug administration of 300 mg TSI.
Five hundred twenty CF patients with chronic Pseudomonas aeruginosa endobronchial infections.
A logistic regression analysis identified factors contributing to increased S maltophilia isolation frequency. In this multivariate analysis, the only significant predictors of S maltophilia isolation during the last month of the trial were the concomitant use of oral quinolones (primarily ciprofloxacin; p = 0.0015) and S maltophilia isolation prior to treatment (p < 0.0001). Treatment group, gender, age, use of systemic or inhaled steroids, use of oral sulfonamide, IV cephalosporins, or penicillin antibiotics, baseline FEV(1) percent predicted, and pretreatment Aspergillus isolation were not significant predictors of subsequent S maltophilia infection. In addition, S maltophilia-positive culture frequency was compared to the change in pulmonary function. Patients who either never had culture results positive for S maltophilia or who were positive at <25% of observations had greater clinical response to TSI at the final study visit compared to patients who were positive at > or = 25% of observations.
TSI therapy did not result in a greater risk for isolation of S maltophilia than standard care alone. In contrast, oral quinolone antibiotic use during the trial was associated with a 2.7-fold increased risk of having a culture positive for S maltophilia (p = 0.0015). The use of TSI to suppress P aeruginosa resulted in improved lung function, regardless of S maltophilia culture frequency. However, improvement was not as great among patients who were persistently coinfected with S maltophilia.
确定致使囊性纤维化（CF）患者易发生嗜麦芽窄食单胞菌感染的因素，并确定与嗜麦芽窄食单胞菌合并感染是否会影响吸入用妥布霉素溶液（TSI）300mg每日两次治疗的临床反应。
对从两项相同的为期6个月的随机、安慰剂对照试验收集的数据进行回顾性分析。
美国69个CF中心。
给予300mg TSI活性药物。
520例患有慢性铜绿假单胞菌支气管内感染的CF患者。
逻辑回归分析确定了导致嗜麦芽窄食单胞菌分离频率增加的因素。在这项多变量分析中，试验最后一个月嗜麦芽窄食单胞菌分离的唯一显著预测因素是同时使用口服喹诺酮类药物（主要是环丙沙星；p = 0.0015）以及治疗前嗜麦芽窄食单胞菌的分离情况（p < 0.0001）。治疗组、性别、年龄、全身或吸入性类固醇的使用、口服磺胺类药物、静脉用头孢菌素或青霉素类抗生素的使用、预测的基线第一秒用力呼气容积（FEV₁）百分比以及治疗前曲霉菌的分离情况均不是随后嗜麦芽窄食单胞菌感染的显著预测因素。此外，将嗜麦芽窄食单胞菌阳性培养频率与肺功能变化进行了比较。与在≥25%的观察中呈阳性的患者相比，那些嗜麦芽窄食单胞菌培养结果从未呈阳性或在<25%的观察中呈阳性的患者在最终研究访视时对TSI的临床反应更好。
与单独的标准治疗相比，TSI治疗并未导致嗜麦芽窄食单胞菌分离的风险更高。相反，试验期间使用口服喹诺酮类抗生素使嗜麦芽窄食单胞菌培养呈阳性的风险增加了2.7倍（p = 0.0015）。使用TSI抑制铜绿假单胞菌可改善肺功能，无论嗜麦芽窄食单胞菌培养频率如何。然而，在持续合并嗜麦芽窄食单胞菌感染的患者中改善程度没有那么大。
