Holty Jon-Erik C, Bravata Dena M, Liu Hau, Olshen Richard A, McDonald Kathryn M, Owens Douglas K
Division of Pulmonary and Critical Care Medicine, Stanford University, San Francisco, California 94305-5236, USA.
Ann Intern Med. 2006 Feb 21;144(4):270-80. doi: 10.7326/0003-4819-144-4-200602210-00009.
Mortality from inhalational anthrax during the 2001 U.S. attack was substantially lower than that reported historically.
To systematically review all published inhalational anthrax case reports to evaluate the predictors of disease progression and mortality.
MEDLINE (1966-2005), 14 selected journal indexes (1900-1966), and bibliographies of all retrieved articles.
Case reports (in any language) between 1900 and 2005 that met predefined criteria.
Two authors (1 author for non-English-language reports) independently abstracted patient data.
The authors found 106 reports of 82 cases of inhalational anthrax. Mortality was statistically significantly lower for patients receiving antibiotics or anthrax antiserum during the prodromal phase of disease, multidrug antibiotic regimens, or pleural fluid drainage. Patients in the 2001 U.S. attack were less likely to die than historical anthrax case-patients (45% vs. 92%; P < 0.001) and were more likely to receive antibiotics during the prodromal phase (64% vs. 13%; P < 0.001), multidrug regimens (91% vs. 50%; P = 0.027), or pleural fluid drainage (73% vs. 11%; P < 0.001). Patients who progressed to the fulminant phase had a mortality rate of 97% (regardless of the treatment they received), and all patients with anthrax meningoencephalitis died.
This was a retrospective case review of previously published heterogeneous reports.
Despite advances in supportive care, fulminant-phase inhalational anthrax is usually fatal. Initiation of antibiotic or anthrax antiserum therapy during the prodromal phase is associated with markedly improved survival, although other aspects of care, differences in clinical circumstances, or unreported factors may contribute to this observed reduction in mortality. Efforts to improve early diagnosis and timely initiation of appropriate antibiotics are critical to reducing mortality.
2001年美国炭疽袭击事件中吸入性炭疽的死亡率显著低于历史报告的死亡率。
系统回顾所有已发表的吸入性炭疽病例报告，以评估疾病进展和死亡率的预测因素。
MEDLINE（1966 - 2005年）、14种选定的期刊索引（1900 - 1966年）以及所有检索文章的参考文献。
1900年至2005年间符合预定义标准的病例报告（任何语言）。
两名作者（非英语报告由一名作者负责）独立提取患者数据。
作者发现了82例吸入性炭疽的106份报告。在疾病前驱期接受抗生素或炭疽抗血清治疗、多药联合抗生素治疗方案或胸腔积液引流的患者，其死亡率在统计学上显著降低。2001年美国炭疽袭击事件中的患者比历史炭疽病例患者死亡可能性更低（45%对92%；P < 0.001），且在前驱期更有可能接受抗生素治疗（64%对13%；P < 0.001）、多药治疗方案（91%对50%；P = 0.027）或胸腔积液引流（73%对11%；P < 0.001）。进展为暴发性阶段的患者死亡率为97%（无论接受何种治疗），所有患炭疽性脑膜脑炎的患者均死亡。
这是对先前发表的异质性报告的回顾性病例研究。
尽管支持治疗有所进展，但暴发性阶段的吸入性炭疽通常是致命的。在前驱期开始抗生素或炭疽抗血清治疗与生存率显著提高相关，尽管护理的其他方面、临床情况的差异或未报告的因素可能导致观察到的死亡率降低。改善早期诊断和及时开始使用适当抗生素对于降低死亡率至关重要。
