Regan Kate H, Bhatt Jayesh
NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK, EH16 4SA.
Cochrane Database Syst Rev. 2016 Nov 2;11:CD009876. doi: 10.1002/14651858.CD009876.pub3.
Chronic infection with Burkholderia cepacia complex species remains a significant problem for clinicians treating people with cystic fibrosis. Colonisation with Burkholderia cepacia complex species is linked to a more rapid decline in lung function and increases morbidity and mortality. There remain no objective guidelines for strategies to eradicate Burkholderia cepacia complex in cystic fibrosis lung disease, as these are inherently resistant to the majority of antibiotics and there has been very little research in this area. This review aims to examine the current treatment options for people with cystic fibrosis with acute of Burkholderia cepacia complex and to identify an evidence-based strategy that is both safe and effective. This is an updated version of the review.
To identify whether treatment of Burkholderia cepacia complex infections can achieve eradication, or if treatment can prevent or delay the onset of chronic infection. To establish whether following eradication, clinical outcomes are improved and if there are any adverse effects.
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.Last search: 14 July 2016.We also searched electronic clinical trials registers for the USA and Europe.Date of last search: 14 July 2016.
Randomised or quasi-randomised studies in people with cystic fibrosis of antibiotics or alternative therapeutic agents used alone or in combination, using any method of delivery and any treatment duration, to eradicate Burkholderia cepacia complex infections compared to another antibiotic, placebo or no treatment.
Two authors independently assessed for inclusion in the review the eligibility of 50 studies (70 references) identified by the search of the Group's Trial Register and the other electronic searches.
No studies looking at the eradication of Burkholderia cepacia complex species were identified.
AUTHORS' CONCLUSIONS: The authors have concluded that there was an extreme lack of evidence in this area of treatment management for people with cystic fibrosis. Without further comprehensive studies, it is difficult to draw conclusions about a safe and effective management strategy for Burkholderia cepacia complex eradication in cystic fibrosis. Thus, while the review could not offer clinicians evidence of an effective eradication protocol for Burkholderia cepacia complex, it has highlighted an urgent need for exploration and research in this area, specifically the need for well-designed multi-centre randomised controlled studies of a variety of (novel) antibiotic agents.
洋葱伯克霍尔德菌复合体菌种的慢性感染对于治疗囊性纤维化患者的临床医生而言，仍然是一个重大问题。感染洋葱伯克霍尔德菌复合体菌种与肺功能更快下降相关，并会增加发病率和死亡率。目前仍没有根除囊性纤维化肺部疾病中洋葱伯克霍尔德菌复合体的客观策略指南，因为这些细菌对大多数抗生素具有固有抗性，且该领域的研究非常少。本综述旨在研究针对患有急性洋葱伯克霍尔德菌复合体感染的囊性纤维化患者的当前治疗选择，并确定一种安全有效的循证策略。这是该综述的更新版本。
确定治疗洋葱伯克霍尔德菌复合体感染是否能实现根除，或者治疗是否能预防或延迟慢性感染的发生。确定根除后临床结局是否得到改善以及是否有任何不良反应。
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。最后检索日期：2016年7月14日。我们还检索了美国和欧洲的电子临床试验注册库。最后检索日期：2016年7月14日。
针对囊性纤维化患者使用单独或联合的抗生素或替代治疗药物进行的随机或半随机研究，采用任何给药方法和任何治疗持续时间，以根除洋葱伯克霍尔德菌复合体感染，并与另一种抗生素、安慰剂或不治疗进行比较。
两位作者独立评估了通过检索该小组的试验注册库和其他电子检索确定的50项研究（70篇参考文献）是否符合纳入本综述的条件。
未发现有关根除洋葱伯克霍尔德菌复合体菌种的研究。
作者得出结论，在该囊性纤维化治疗管理领域极度缺乏证据。没有进一步的全面研究，很难就根除囊性纤维化中洋葱伯克霍尔德菌复合体的安全有效管理策略得出结论。因此，虽然本综述无法为临床医生提供有效根除洋葱伯克霍尔德菌复合体方案的证据，但它突出了该领域探索和研究的迫切需求，特别是对各种（新型）抗生素药物进行精心设计的多中心随机对照研究的需求。
