Departments of Medicine, and Microbiology and Infectious Disease, University of Calgary, Calgary, AB, Canada; Northern Ireland Regional Adult Cystic Fibrosis Centre, Belfast City Hospital, Belfast, Ireland.
Northern Ireland Regional Adult Cystic Fibrosis Centre, Belfast City Hospital, Belfast, Ireland.
Chest. 2012 Feb;141(2):485-493. doi: 10.1378/chest.11-0917. Epub 2011 Aug 11.
Pulmonary exacerbations (PEx) are responsible for much of the morbidity and mortality associated with cystic fibrosis (CF). However, there is a paucity of data on outcomes in CF PEx and factors influencing outcomes.
We reviewed all PEx in patients infected with Pseudomonas aeruginosa treated with parenteral antibiotics over 4 years at our center. Treatment failures were categorized a priori as those PEx requiring antibiotic regimen change, prolongation of therapy > 20 days because of failure to respond, an early recurrent event within < 45 days, or failure to recover lung function to > 90% of baseline FEV(1).
A total of 101 patients were followed for 452 PEx. Treatment failures were observed in 125 (28%) of PEx; antibiotic regimen change was observed in 27 (6%), prolongation of therapy in 29 (6%), early recurrent events in 63 (14%), and failure to recover lung function to > 90% of baseline FEV(1) in 66 (15%). Demographic factors associated with one or more treatment failures per year included advanced airways disease, use of enteric feeds, CF-related diabetes, and CF liver disease but did not include female sex or F508del homozygosity. Increased treatment failure risk was associated with lower admission FEV(1) and increased markers of inflammation. At therapeutic completion, increased inflammatory markers correlated with treatment failure. Failure rates decreased with increasing number of active antimicrobial agents used based on in vitro susceptibility (zero, 28/65 [43%]; one, 38/140 [27%]; two, 59/245 [24%]; three, 0/2 [0%]; P = .02).
One-fourth of PEx fail to respond adequately to initial management. Patient demographic and episode-specific clinical information can be used to identify individuals at increased risk of initial management failure.
肺部恶化（PEx）是导致囊性纤维化（CF）患者发病率和死亡率的主要原因。然而，关于 CF PEx 的结果和影响结果的因素的数据很少。
我们回顾了在我们中心接受过 4 年静脉用抗生素治疗的感染铜绿假单胞菌的患者的所有 PEx。预先将治疗失败分为以下几类：需要改变抗生素方案的 PEx，因治疗无效而延长治疗时间>20 天，45 天内早期复发，或未能将肺功能恢复到>90%的基线 FEV（1）。
共随访了 101 例患者的 452 次 PEx。125 次（28%）PEx 观察到治疗失败；27 次（6%）观察到抗生素方案改变，29 次（6%）延长治疗时间，63 次（14%）早期复发，66 次（15%）未能将肺功能恢复到>90%的基线 FEV（1）。每年发生一次或多次治疗失败的相关因素包括气道疾病晚期、使用肠内喂养、CF 相关糖尿病和 CF 肝病，但不包括女性性别或 F508del 纯合子。入院时 FEV（1）较低和炎症标志物增加与治疗失败风险增加相关。在治疗结束时，炎症标志物增加与治疗失败相关。基于体外药敏性，使用的活性抗菌药物数量越多，失败率越低（零，65/65 [43%]；一，140/140 [27%]；二，245/245 [24%]；三，2/2 [0%]；P=0.02）。
四分之一的 PEx 对初始治疗反应不足。患者的人口统计学和特定于发作的临床信息可用于识别初始治疗失败风险增加的个体。
