University of Washington, Seattle, WA, USA.
University of Calgary, Calgary, AB, Canada.
J Cyst Fibros. 2019 Mar;18(2):236-243. doi: 10.1016/j.jcf.2019.01.008. Epub 2019 Jan 30.
Antimicrobial susceptibility testing (AST) is a cornerstone of infection management. Cystic fibrosis (CF) treatment guidelines recommend AST to select antimicrobial treatments for CF airway infection but its utility in this setting has never been objectively demonstrated.
We conducted a systematic review of primary published articles designed to address two PICO (patient, intervention, comparator, outcome) questions: 1) "For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection predictable from AST results available at treatment initiation?" and 2) "For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection affected by the method used to guide antimicrobial selection?" Relationships between AST results and clinical response (changes in pulmonary function, weight, signs and symptoms of respiratory tract infection, and time to next event) were assessed for each article and results were compared across articles when possible.
Twenty-five articles describing the results of 20 separate studies, most of which described Pseudomonas aeruginosa treatment, were identified. Thirteen studies described pulmonary exacerbation (PEx) treatment and seven described 'maintenance' of chronic bacterial airways infection. In only three of 16 studies addressing PICO question #1 was there a suggestion that baseline bacterial isolate antimicrobial susceptibility was associated with clinical response to treatment. None of the four studies addressing PICO question #2 suggested that antimicrobial selection methods influenced clinical outcomes.
There is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment, suggesting a need for careful consideration of current AST use by the CF community.
抗菌药物敏感性测试（AST）是感染管理的基石。囊性纤维化（CF）治疗指南建议进行 AST，以选择 CF 气道感染的抗菌治疗，但在这种情况下，AST 的实用性从未得到客观证明。
我们进行了一项系统评价，主要针对两个 PICO（患者、干预、比较、结局）问题的已发表的原始文章：1）“对于 CF 患者，抗菌治疗细菌气道感染的临床反应是否可从开始治疗时获得的 AST 结果预测？”和 2）“对于 CF 患者，抗菌治疗细菌气道感染的临床反应是否受到指导抗菌药物选择的方法影响？”评估了每篇文章中 AST 结果与临床反应（肺功能、体重、呼吸道感染的体征和症状变化，以及下一次事件的时间）之间的关系，并在可能的情况下比较了各文章之间的结果。
确定了 25 篇描述 20 项独立研究结果的文章，其中大多数描述了铜绿假单胞菌的治疗。13 项研究描述了肺部加重（PEx）治疗，7 项研究描述了慢性细菌气道感染的“维持”治疗。在 16 项研究中，只有 3 项研究表明基线细菌分离物的抗菌药物敏感性与治疗反应相关。在 4 项研究中，没有一项研究表明抗菌药物选择方法影响临床结果。
AST 预测 CF 抗菌治疗的临床结局的证据很少，这表明 CF 社区需要仔细考虑当前 AST 的使用。
