Waters Valerie, Ratjen Felix
Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD006961. doi: 10.1002/14651858.CD006961.pub2.
Antibiotic therapy for acute pulmonary exacerbations in people with cystic fibrosis (CF) is usually chosen based on the results of antimicrobial susceptibility testing of individual drugs. Combination antimicrobial susceptibility testing assesses the efficacy of drug combinations including two or three antibiotics in vitro and can often demonstrate antimicrobial efficacy against bacterial isolates even when individual antibiotics have little or no effect. Therefore, choosing antibiotics based on combination antimicrobial susceptibility testing could potentially improve response to treatment in people with CF with acute exacerbations.
To compare antibiotic therapy based on conventional antimicrobial susceptibility testing to antibiotic therapy based on combination antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with CF and chronic infection with P. aeruginosa.
We identified relevant trials from the Group's Cystic Fibrosis Trials Register. Most recent search: November 2007.
Randomised and quasi-randomised controlled trials of antibiotic therapy based on conventional antimicrobial susceptibility testing compared to antibiotic therapy based on combination antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in CF due to chronic infection with P. aeruginosa.
Both authors independently selected trials, assessed their quality and extracted data from eligible studies. Additionally, the authors contacted the study investigators to obtain further information.
The search identified one study eligible for inclusion in the review. This study prospectively assessed whether the use of multiple combination bactericidal antibiotic testing (MCBT) improved clinical outcomes in participants with acute pulmonary exacerbations of CF who were infected with multiresistant bacteria. 132 participants were randomised in the study. The study investigators provided data specific to the participants who were only infected with P. aeruginosa for the primary outcome: time until next pulmonary exacerbation. For "Time to next pulmonary exacerbation" in the participants specifically infected with only P. aeruginosa, the hazard ratio was 0.82, favouring the control group (95% CI 0.44 to 1.51) (P = 0.52). The data did not provide evidence that combination susceptibility testing was superior to conventional susceptibility testing.
AUTHORS' CONCLUSIONS: The current evidence, limited to one study, shows that there is insufficient evidence to determine effect of choosing antibiotics based on combination antimicrobial susceptibility testing compared to choosing antibiotics based on conventional antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with CF with chronic P. aeruginosa infection. A large international and multicentre trial is needed to further investigate this issue.
囊性纤维化（CF）患者急性肺部加重期的抗生素治疗通常根据个别药物的抗菌药敏试验结果来选择。联合抗菌药敏试验可在体外评估包括两种或三种抗生素的药物组合的疗效，即使个别抗生素效果不佳或无效果，联合试验也常常能显示出对细菌分离株的抗菌效果。因此，基于联合抗菌药敏试验选择抗生素可能会改善CF急性加重期患者的治疗反应。
比较基于传统抗菌药敏试验的抗生素治疗与基于联合抗菌药敏试验的抗生素治疗在CF患者急性肺部加重期及铜绿假单胞菌慢性感染治疗中的效果。
我们从该组织的囊性纤维化试验注册库中识别相关试验。最近一次检索时间为2007年11月。
将基于传统抗菌药敏试验的抗生素治疗与基于联合抗菌药敏试验的抗生素治疗用于CF患者因铜绿假单胞菌慢性感染导致的急性肺部加重期治疗的随机和半随机对照试验。
两位作者独立选择试验、评估其质量并从符合条件的研究中提取数据。此外，作者联系了研究调查人员以获取更多信息。
检索确定了一项符合纳入综述条件的研究。该研究前瞻性评估了使用多重联合杀菌抗生素试验（MCBT）是否能改善感染多重耐药菌的CF急性肺部加重期参与者的临床结局。132名参与者被随机分组。研究调查人员提供了仅感染铜绿假单胞菌的参与者的主要结局特定数据：直至下一次肺部加重的时间。对于仅感染铜绿假单胞菌的参与者，“至下一次肺部加重的时间”的风险比为0.82，有利于对照组（95%CI 0.44至1.51）（P = 0.52）。数据未提供联合药敏试验优于传统药敏试验的证据。
目前的证据（仅限于一项研究）表明，在CF合并铜绿假单胞菌慢性感染患者的急性肺部加重期治疗中，与基于传统抗菌药敏试验选择抗生素相比，基于联合抗菌药敏试验选择抗生素的效果尚无足够证据确定。需要进行一项大型国际多中心试验来进一步研究这个问题。
