吸入性抗生素降低重度神经疾病患者呼吸道感染频率：一项回顾性数据分析
Reducing the frequency of respiratory tract infections in severe neurological disorders by inhaled antibiotics: a retrospective data analysis.
作者信息
Eckerland Maximilian, Bock Claudia, Olivier Margarete, Pichlmaier Leopold, Steindor Mathis, Stehling Florian
机构信息
Dept of Pediatric Pulmonology and Sleep Medicine, University of Duisburg-Essen, Children's Hospital, Essen, Germany.
出版信息
ERJ Open Res. 2019 Jul 22;5(3). doi: 10.1183/23120541.00149-2018. eCollection 2019 Jul.
BACKGROUND
In patients with severe neurological impairment, recurrent respiratory tract infections frequently occur as a result of impaired clearance of airway secretions and microbial airway colonisation. We hypothesised that inhaled antibiotic therapy may improve the morbidity of these patients.
METHODS
A retrospective data analysis of 20 patients (11 nontracheotomised and nine tracheotomised) with neurological impairment and microbial airway colonisation was carried out at a children's university hospital. Two questionnaires that asked about the number of respiratory tract infections, antibiotic therapies and hospitalisations were distributed to the patients/caregivers: a first questionnaire representing the 12 months prior to the initiation of inhaled antibiotics and a second questionnaire describing the first 12 months under therapy.
RESULTS
During the first 12 months of therapy, the frequency of respiratory tract infections among all participants was reduced from a mean of 6.8 episodes (median (interquartile range (IQR)) 6.0 (4.0-10.0) episodes) to a mean of 2.5 episodes (median (IQR) 2.0 (1.0-3.0) episodes; p<0.001). In addition, a significant decrease of systemic antibiotic therapies (mean 7.7, median (IQR) 6.0 (4.0-10.0) 2.5, 2.5 (0.0-3.75) episodes; p<0.001) and hospitalisations (mean 3.9, median (IQR) 3.5 (1.0-5.0) 0.9, 0.0 (0.0-1.0) episodes; p<0.001) was noted. This significant therapeutic effect could be demonstrated in a subgroup analysis in both tracheotomised and nontracheotomised subjects. The reduction of respiratory tract infections and systemic antibiotic therapies (and thus the therapeutic success) was significantly greater in the nontracheotomised group compared with the tracheotomised group.
CONCLUSIONS
The presented data suggest that inhaled antibiotics might play a role in treating recurrent respiratory tract infections in neuromuscular diseases.
背景
在患有严重神经功能障碍的患者中，由于气道分泌物清除功能受损和气道微生物定植，反复发生呼吸道感染。我们推测吸入抗生素治疗可能会改善这些患者的发病率。
方法
在一家儿童医院对20例患有神经功能障碍和气道微生物定植的患者（11例未行气管切开术，9例已行气管切开术）进行了回顾性数据分析。向患者/护理人员发放了两份问卷，询问呼吸道感染次数、抗生素治疗情况和住院情况：第一份问卷代表开始吸入抗生素治疗前的12个月，第二份问卷描述治疗后的前12个月。
结果
在治疗的前12个月，所有参与者的呼吸道感染频率从平均6.8次发作（中位数（四分位间距（IQR））6.0（4.0 - 10.0）次发作）降至平均2.5次发作（中位数（IQR）2.0（1.0 - 3.0）次发作；p<0.001）。此外，全身抗生素治疗（平均7.7次，中位数（IQR）6.0（4.0 - 10.0）次降至2.5次，2.5（0.0 - 3.75）次发作；p<0.001）和住院次数（平均3.9次，中位数（IQR）3.5（1.0 - 5.0）次降至0.9次，0.0（0.0 - 1.0）次发作；p<0.001）均显著减少。在气管切开组和未气管切开组的亚组分析中均证实了这一显著的治疗效果。与气管切开组相比，未气管切开组呼吸道感染和全身抗生素治疗的减少（即治疗成功率）显著更大。
结论
所呈现的数据表明吸入抗生素可能在治疗神经肌肉疾病中的反复呼吸道感染中发挥作用。
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