1 Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Am Thorac Soc. 2014 Dec;11(10):1640-50. doi: 10.1513/AnnalsATS.201404-166OC.
The Cystic Fibrosis (CF) Foundation developed clinical care guidelines for the prevention of Pseudomonas aeruginosa infection, the treatment of initial P. aeruginosa infection, and the use of bronchoscopy to obtain routine airway cultures in individuals with CF.
A multidisciplinary committee developed questions about the prevention and treatment of initial P. aeruginosa infection and the use of bronchoscopy to obtain routine airway cultures. The outcome measure of interest was cultures without P. aeruginosa growth. Systematic reviews of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted in May 2012 and August 2013. Searches combined controlled vocabulary terms and text words for CF and terms relevant to each question. The entire committee reviewed the evidence, and final recommendation statements were graded using the U.S. Preventive Services Task Force system. Recommendation 1: The CF Foundation strongly recommends inhaled antibiotic therapy for the treatment of initial or new growth of P. aeruginosa from an airway culture (certainty of net benefit, high; estimate of net benefit, substantial; grade of recommendation, A). The favored antibiotic regimen is inhaled tobramycin (300 mg twice daily) for 28 days. Recommendation 2: The CF Foundation recommends against the use of prophylactic antipseudomonal antibiotics to prevent the acquisition P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, zero; grade of recommendation, D). Recommendation 3: The CF Foundation recommends routine oropharyngeal cultures rather than bronchoalveolar lavage cultures obtained by bronchoscopy in individuals with CF who cannot expectorate sputum to determine if they are infected with P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, moderate; grade of recommendation, B).
囊性纤维化基金会制定了预防铜绿假单胞菌感染、治疗初始铜绿假单胞菌感染以及使用支气管镜获取囊性纤维化患者常规气道培养物的临床护理指南。
一个多学科委员会就预防和治疗初始铜绿假单胞菌感染以及使用支气管镜获取常规气道培养物的问题制定了问题。感兴趣的结局测量是无铜绿假单胞菌生长的培养物。2012 年 5 月和 2013 年 8 月对 PubMed、EMBASE 和 Cochrane 中央对照试验注册中心进行了系统评价。搜索结合了 CF 的受控词汇术语和文本词以及与每个问题相关的术语。整个委员会审查了证据，最终推荐声明使用美国预防服务工作组系统进行分级。推荐 1：囊性纤维化基金会强烈建议使用吸入抗生素疗法治疗气道培养物中新出现或新生长的铜绿假单胞菌（净效益确定性高；净效益估计值大；推荐等级 A）。首选的抗生素方案是吸入妥布霉素（每天 2 次，每次 300mg）28 天。推荐 2：囊性纤维化基金会不建议使用预防性抗假单胞菌抗生素来预防铜绿假单胞菌的获得（净效益确定性中度；净效益估计值为零；推荐等级 D）。推荐 3：囊性纤维化基金会建议对无法咳出痰液的患者进行常规或口咽培养，而不是使用支气管镜进行支气管肺泡灌洗培养，以确定其是否感染铜绿假单胞菌（净效益确定性中度；净效益估计值中度；推荐等级 B）。
