Com Gulnur, Agarwal Amit, Bai Shasha, Hu Zhuopei, Goode Grace, McCarty Hollyn, Berlinski Ariel
Department of Pediatric Pulmonology, University of Florida, Pensacola, Florida.
Department of Pediatric Pulmonology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Pediatr Allergy Immunol Pulmonol. 2019 Dec 1;32(4):149-154. doi: 10.1089/ped.2019.1073. Epub 2019 Dec 11.
Pulmonary exacerbations (PExs) are common in individuals with cystic fibrosis (CF). Data regarding outcomes of outpatient parenteral antimicrobial therapy (OPAT) in children are sparse. Retrospective data of PEx episodes treated in the hospital versus OPAT collected. Children ≤18 years were included. Outcome measures included FEV, FVC, FEF%, time to the next PEx, and weight gain. Eighty-three subjects with 290 PEx events were eligible. The hospital group had 242 and the OPAT group had 48 PEx events. The median age was 13.1 years for the OPAT and 13.4 years for the hospital group. Medicaid coverage was higher in the hospital group (82.2%) versus OPAT group (48.9%, < 0.0001). The hospital group had lower FEV% on admission [72% (interquartile range [IQR] = 59.7 and 84) versus 80% (IQR = 70.7 and 89); = 0.001] and at the end of treatment [86% (IQR = 72 and 96.7) versus 92% (IQR = 82 and 101); = 0.003] in comparison with OPAT group. FEV% improved more in the hospital group, [12% (IQR = 4 and 20)] versus in the OPAT group [8% (IQR = 2 and 22.5); ( = 0.41)] but did not quite reach a statistically significant level. The hospital intravenous (IV) group gained more weight ( < 0.0001). There was no difference between the 2 groups in time to the first PEx ( = 0.47) and adverse events. OPAT was safe and comparable with hospital therapy in a select group of children with CF. Hospital IV should be considered for sicker children and families with limited resources.
肺部加重（PExs）在囊性纤维化（CF）患者中很常见。关于儿童门诊胃肠外抗菌治疗（OPAT）结果的数据很少。收集了在医院治疗与OPAT治疗的PEx发作的回顾性数据。纳入了18岁及以下的儿童。结局指标包括第一秒用力呼气容积（FEV）、用力肺活量（FVC）、用力呼气流量百分比（FEF%）、下次PEx发作的时间以及体重增加情况。83名受试者共发生290次PEx事件，符合条件。医院治疗组有242次PEx事件，OPAT组有48次PEx事件。OPAT组的中位年龄为13.1岁，医院治疗组为13.4岁。医院治疗组的医疗补助覆盖率更高（82.2%），而OPAT组为48.9%（P<0.0001）。与OPAT组相比，医院治疗组入院时的FEV%较低[72%（四分位间距[IQR]=59.7和84）对80%（IQR=70.7和89）；P=0.001]，治疗结束时也较低[86%（IQR=72和96.7）对92%（IQR=82和101）；P=0.003]。医院治疗组的FEV%改善幅度更大，为[12%（IQR=4和20）]，而OPAT组为[8%（IQR=2和22.5）；P=0.41]，但未达到统计学显著水平。医院静脉注射（IV）组体重增加更多（P<0.0001）。两组首次发生PEx的时间（P=0.47）和不良事件方面没有差异。在一组特定的CF儿童中，OPAT是安全的，且与医院治疗相当。对于病情较重的儿童和资源有限的家庭，应考虑采用医院静脉注射治疗。
