对患有囊性纤维化且肺部病情加重的患者使用抗生素治疗洋葱伯克霍尔德菌复合体。
Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation.
作者信息
Horsley Alex, Jones Andrew M, Lord Robert
机构信息
School of Translational Medicine, University Hospital of South Manchester, Southmoor Road, Manchester, UK, M23 9LT.
出版信息
Cochrane Database Syst Rev. 2016 Jan 20;2016(1):CD009529. doi: 10.1002/14651858.CD009529.pub3.
BACKGROUND
Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 18 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with a fulminant necrotising pneumonia. Burkholderia cepacia complex bacteria are resistant to many common antibiotics and able to acquire resistance against many more. Following patient segregation in cystic fibrosis medical care, the more virulent epidemic strains are not as frequent, and new infections are more likely to be with less virulent environmentally-acquired strains. Although evidence-based guidelines exist for treating respiratory exacerbations involving Pseudomonas aeruginosa, these cannot be extended to Burkholderia cepacia complex infections. This review, which is an update of a previous review, aims to assess the available trial evidence for the choice and application of treatments for these infections.
OBJECTIVES
To assess the effectiveness and safety of different antibiotic regimens in people with cystic fibrosis experiencing an exacerbation and chronically infected with organisms of the Burkholderia cepacia complex.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of latest search: 28 August 2015.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials of treatments for exacerbations of pulmonary symptoms in people with cystic fibrosis chronically infected with organisms of the Burkholderia cepacia complex.
DATA COLLECTION AND ANALYSIS
No relevant trials were identified.
MAIN RESULTS
No trials were included in this review.
AUTHORS' CONCLUSIONS: Burkholderia cepacia complex infections present a significant challenge for people with cystic fibrosis and their clinicians. The incidence is likely to increase as the cystic fibrosis population ages; and managing and treating these infections will become more important. There is a lack of trial evidence to guide decision making and no conclusions can be drawn from this review about the optimal antibiotic regimens for people with cystic fibrosis who have chronic Burkholderia cepacia complex infections. Clinicians must continue to assess each person individually, taking into account in vitro antibiotic susceptibility data, previous clinical responses and their own experience. Multicentre randomised clinical trials are needed to assess the effectiveness of different antibiotic regimens in people with cystic fibrosis infected with organisms of the Burkholderia cepacia complex.
背景
慢性肺部感染是囊性纤维化肺病的一个标志。由洋葱伯克霍尔德菌复合体（一组至少18种密切相关的革兰氏阴性菌）引起的感染尤其难以治疗。这些感染可能与暴发性坏死性肺炎有关。洋葱伯克霍尔德菌复合体细菌对许多常见抗生素耐药，并且还能够获得对更多抗生素的耐药性。在囊性纤维化医疗中对患者进行隔离后，毒性更强的流行菌株不再那么常见，新感染更可能是由毒性较弱的环境获得性菌株引起。尽管存在针对涉及铜绿假单胞菌的呼吸道加重的循证指南，但这些指南不能扩展到洋葱伯克霍尔德菌复合体感染。本综述是对先前综述的更新，旨在评估针对这些感染的治疗选择和应用的现有试验证据。
目的
评估不同抗生素方案对患有洋葱伯克霍尔德菌复合体感染并出现病情加重的囊性纤维化患者的有效性和安全性。
检索方法
我们检索了Cochrane囊性纤维化试验注册库，该注册库通过电子数据库检索以及对期刊和会议摘要集的手工检索汇编而成。我们还检索了相关文章和综述的参考文献列表。最新检索日期：2015年8月28日。
选择标准
针对长期感染洋葱伯克霍尔德菌复合体的囊性纤维化患者肺部症状加重的治疗的随机和半随机对照试验。
数据收集与分析
未识别出相关试验。
主要结果
本综述未纳入任何试验。
作者结论
洋葱伯克霍尔德菌复合体感染对囊性纤维化患者及其临床医生构成重大挑战。随着囊性纤维化患者群体老龄化，发病率可能会增加；管理和治疗这些感染将变得更加重要。缺乏试验证据来指导决策，并且本综述无法就患有慢性洋葱伯克霍尔德菌复合体感染的囊性纤维化患者的最佳抗生素方案得出结论。临床医生必须继续对每个患者进行个体评估，考虑体外抗生素敏感性数据、既往临床反应和他们自己的经验。需要进行多中心随机临床试验来评估不同抗生素方案对感染洋葱伯克霍尔德菌复合体的囊性纤维化患者的有效性。
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