Garinis Angela C, Cross Campbell P, Srikanth Priya, Carroll Kelly, Feeney M Patrick, Keefe Douglas H, Hunter Lisa L, Putterman Daniel B, Cohen David M, Gold Jeffrey A, Steyger Peter S
Otolaryngology, Oregon Health & Science University, Portland, OR, United States; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States.
Otolaryngology, Oregon Health & Science University, Portland, OR, United States; School of Medicine, Oregon Health & Science University, Portland, OR, United States.
J Cyst Fibros. 2017 May;16(3):401-409. doi: 10.1016/j.jcf.2017.01.006. Epub 2017 Feb 24.
Aminoglycosides (AGs) and glycopeptides are antibiotics essential for treating life-threatening respiratory infections in patients with cystic fibrosis (CF). The goal of this study was to examine the effects of cumulative intravenous (IV)-AG (amikacin and/or tobramycin) and/or glycopeptide (vancomycin) dosing on hearing status in patients with CF.
Hearing thresholds were measured from 0.25 to 16.0kHz, in 81 participants with CF. Participants were categorized into two groups: normal hearing in both ears (≤25dB HL for all frequency bands) or hearing loss (>25dB HL for any frequency band in either ear). Participants were also characterized into quartiles by their cumulative IV-AG (with or without vancomycin) exposure. Dosing was calculated using two strategies: (i) total number of lifetime doses, and (ii) total number of lifetime doses while accounting for the total doses per day. This was referred to as the "weighted" method.
Participants in the hearing loss group were significantly older than those in the normal-hearing group. After adjusting for gender and age at the time of hearing test, participants in the two highest-quartile exposure groups were almost 5 X more likely to have permanent sensorineural hearing loss than those in the two lowest-quartile exposure groups. There was a small group of CF patients who had normal hearing despite high exposure to IV-antibiotics.
Cumulative IV-antibiotic dosing has a significant negative effect on hearing sensitivity in patients with CF, when controlling for age and gender effects. A trend for increasing odds of hearing loss was associated with increasing cumulative IV-antibiotic dosing.
氨基糖苷类抗生素（AGs）和糖肽类抗生素是治疗囊性纤维化（CF）患者危及生命的呼吸道感染所必需的抗生素。本研究的目的是探讨静脉注射AG（阿米卡星和/或妥布霉素）和/或糖肽类抗生素（万古霉素）的累积剂量对CF患者听力状况的影响。
对81名CF患者进行听力阈值测量，频率范围为0.25至16.0kHz。参与者分为两组：双耳听力正常（所有频段≤25dB HL）或听力损失（任一耳的任何频段>25dB HL）。参与者还根据其静脉注射AG（有或没有万古霉素）的累积暴露量分为四分位数。剂量计算采用两种策略：（i）终身总剂量，以及（ii）考虑每日总剂量的终身总剂量。这被称为“加权”方法。
听力损失组的参与者明显比听力正常组的参与者年龄大。在调整听力测试时的性别和年龄后，两个最高四分位数暴露组的参与者发生永久性感音神经性听力损失的可能性几乎是两个最低四分位数暴露组参与者的5倍。有一小部分CF患者尽管静脉注射抗生素暴露量高，但听力正常。
在控制年龄和性别影响时，静脉注射抗生素累积剂量对CF患者的听力敏感性有显著负面影响。听力损失几率增加的趋势与静脉注射抗生素累积剂量增加有关。
