National Children's Hospital, Tallaght, Dublin, Ireland.
Curr Med Res Opin. 2012 Jun;28(6):1059-67. doi: 10.1185/03007995.2012.674500. Epub 2012 May 10.
Pseudomonas aeruginosa (Pa) is the predominant pathogen infecting the airways of patients with cystic fibrosis (CF). Initial colonization is usually transient and associated with non-mucoid strains, which can be eradicated if identified early. This strategy can prevent, or at least delay, chronic Pa infection, which eventually develops in the majority of patients by their late teens or early adulthood. This article discusses the management and latest treatment developments of Pa lung infection in patients with CF, with a focus on nebulized antibiotic therapy.
PubMed was searched to identify English language articles published up until August 2011 using combinations of the following key words: 'antibiotics', 'chronic', 'cystic fibrosis', 'eradication', 'exacerbations', 'guidelines', 'inhaled', 'intravenous', 'lung infection', 'burden', 'adherence', 'patient segregation', 'pseudomonas aeruginosa' and 'resistance'.
Antibiotics form a central part of the treatment regimens for chronic Pa lung infection. Current treatment guidelines recommend that patients with chronic pulmonary infection with Pa should receive long-term inhaled anti-pseudomonal therapy to preserve lung function, and to reduce the frequency of pulmonary exacerbations and hospital admissions. While antibiotic resistance seems to increase with frequent antibiotic use, this does not appear to impact on clinical outcome. Negative aspects of therapy include the time needed for drug administration and subsequent cleaning of the equipment. These factors cause a significant treatment burden and impact on adherence. The availability of more convenient formulations and delivery vehicles for anti-pseudomonal antibiotics may help overcome some of these challenges.
Current challenges in the management of CF patients with chronic Pa lung infection are numerous. The availability of novel anti-pseudomonal antibiotic formulations/devices is anticipated to improve treatment adherence in patients with CF, and could improve clinical outcomes. Thus, there is hope for improved survival in individuals with CF suffering from chronic pulmonary infection with Pa.
铜绿假单胞菌（Pa）是引起囊性纤维化（CF）患者气道感染的主要病原体。初始定植通常是短暂的，与非粘液型菌株有关，如果早期发现，这些菌株可以被根除。这种策略可以预防或至少延迟大多数患者在十几岁或成年早期发生的慢性 Pa 感染。本文讨论了 CF 患者 Pa 肺部感染的管理和最新治疗进展，重点介绍了雾化抗生素治疗。
使用以下关键词的组合，在 PubMed 上搜索截至 2011 年 8 月发表的英文文章：“抗生素”、“慢性”、“囊性纤维化”、“根除”、“恶化”、“指南”、“吸入”、“静脉内”、“肺部感染”、“负担”、“坚持”、“患者隔离”、“铜绿假单胞菌”和“耐药性”。
抗生素是慢性 Pa 肺部感染治疗方案的核心部分。目前的治疗指南建议，患有慢性肺部 Pa 感染的患者应接受长期吸入抗假单胞菌治疗，以保持肺功能，并减少肺部恶化和住院的频率。虽然抗生素耐药性似乎随着频繁使用抗生素而增加，但这似乎并不影响临床结果。治疗的负面方面包括药物给药所需的时间和随后设备的清洁。这些因素造成了巨大的治疗负担，并影响了患者的依从性。更方便的抗假单胞菌抗生素制剂和给药载体的可用性可能有助于克服其中的一些挑战。
目前 CF 患者慢性 Pa 肺部感染管理面临诸多挑战。新型抗假单胞菌抗生素制剂/器械的出现有望提高 CF 患者的治疗依从性，并改善临床结局。因此，患有慢性肺部 Pa 感染的 CF 患者的生存有望得到改善。
