Smith Sherie, Ratjen Felix, Remmington Tracey, Waters Valerie
Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK.
Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
Cochrane Database Syst Rev. 2020 May 15;5(5):CD006961. doi: 10.1002/14651858.CD006961.pub5.
Antibiotic therapy for acute pulmonary exacerbations in people with cystic fibrosis is usually chosen based on the results of antimicrobial susceptibility testing of individual drugs. Combination antimicrobial susceptibility testing assesses the efficacy of drug combinations including two or three antibiotics in vitro and can often demonstrate antimicrobial efficacy against bacterial isolates even when individual antibiotics have little or no effect. Therefore, choosing antibiotics based on combination antimicrobial susceptibility testing could potentially improve response to treatment in people with cystic fibrosis with acute exacerbations. This is an updated version of a previously published review.
To compare antibiotic therapy based on conventional antimicrobial susceptibility testing to antibiotic therapy based on combination antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with cystic fibrosis and chronic infection with Pseudomonas aeruginosa.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Cystic Fibrosis Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of latest search: 19 March 2020. We also searched ongoing trials registries. Date of latest search: 07 April 2020.
Randomised and quasi-randomised controlled studies of antibiotic therapy based on conventional antimicrobial susceptibility testing compared to antibiotic therapy based on combination antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in cystic fibrosis due to chronic infection with Pseudomonas aeruginosa.
Both authors independently selected studies, assessed their quality and extracted data from eligible studies. Additionally, the authors contacted the study investigators to obtain further information.
The search identified one multicentre study eligible for inclusion in the review. This study prospectively assessed whether the use of multiple combination bactericidal antibiotic testing improved clinical outcomes in participants with acute pulmonary exacerbations of cystic fibrosis who were infected with multiresistant bacteria. A total of 132 participants were randomised in the study. The study investigators provided data specific to the 82 participants who were only infected with Pseudomonas aeruginosa for their primary outcome of time until next pulmonary exacerbation. For participants specifically infected with only Pseudomonas aeruginosa, the hazard ratio of a subsequent exacerbation was 0.82, favouring the control group (95% confidence interval 0.44 to 1.51) (P = 0.52). No further data for any of this review's outcomes specific to participants infected with Pseudomonas aeruginosa were available. The risk of bias for the included study was deemed to be low. The quality of the evidence was moderate for the only outcome providing data solely for individuals with infection due to Pseudomonas aeruginosa. For other outcomes, we were unable to judge the quality of the evidence as no data were available for the relevant subset of participants.
AUTHORS' CONCLUSIONS: The current evidence, limited to one study, shows that there is insufficient evidence to determine effect of choosing antibiotics based on combination antimicrobial susceptibility testing compared to choosing antibiotics based on conventional antimicrobial susceptibility testing in the treatment of acute pulmonary exacerbations in people with cystic fibrosis with chronic Pseudomonas aeruginosa infection. A large international and multicentre study is needed to further investigate this issue. The only study included in the review was published in 2005, and we have not identified any further relevant studies up to March 2017. We therefore do not plan to update this review until new studies are published.
囊性纤维化患者急性肺部加重期的抗生素治疗通常根据个体药物的抗菌药敏试验结果来选择。联合抗菌药敏试验在体外评估包括两种或三种抗生素的药物组合的疗效，并且即使单个抗生素几乎没有或没有效果时，联合抗菌药敏试验通常也能证明对细菌分离株的抗菌效果。因此，基于联合抗菌药敏试验选择抗生素可能会改善囊性纤维化急性加重期患者的治疗反应。这是之前发表的一篇综述的更新版本。
比较基于传统抗菌药敏试验的抗生素治疗与基于联合抗菌药敏试验的抗生素治疗在囊性纤维化患者急性肺部加重期以及铜绿假单胞菌慢性感染治疗中的效果。
我们检索了Cochrane囊性纤维化和遗传疾病小组的囊性纤维化试验注册库，该注册库包含从全面的电子数据库检索以及对相关期刊和会议论文摘要集的手工检索中识别出的参考文献。最新检索日期：2020年3月19日。我们还检索了正在进行的试验注册库。最新检索日期：2020年4月7日。
基于传统抗菌药敏试验的抗生素治疗与基于联合抗菌药敏试验的抗生素治疗在囊性纤维化患者因铜绿假单胞菌慢性感染导致的急性肺部加重期治疗中的随机和半随机对照研究。
两位作者独立选择研究、评估其质量并从符合条件的研究中提取数据。此外，作者联系了研究调查人员以获取更多信息。
检索确定了一项符合纳入本综述条件的多中心研究。该研究前瞻性评估了使用多种联合杀菌抗生素试验是否能改善感染多重耐药菌的囊性纤维化急性肺部加重期参与者的临床结局。该研究共纳入132名参与者并进行随机分组试验。研究调查人员提供了仅感染铜绿假单胞菌的82名参与者的特定数据，用于其主要结局指标——直至下一次肺部加重期的时间。对于仅特定感染铜绿假单胞菌的参与者，后续加重的风险比为0.82，支持对照组（风险比95%置信区间为0.44至1.51）（P = 0.52）。没有可用于本综述中任何针对感染铜绿假单胞菌参与者的特定结局的进一步数据。纳入研究的偏倚风险被认为较低。对于仅为因铜绿假单胞菌感染个体提供数据的唯一结局，证据质量为中等。对于其他结局，由于没有相关参与者子集的数据，我们无法判断证据质量。
目前的证据仅限于一项研究，表明在囊性纤维化合并慢性铜绿假单胞菌感染患者的急性肺部加重期治疗中，与基于传统抗菌药敏试验选择抗生素相比，基于联合抗菌药敏试验选择抗生素的效果尚无足够证据来确定。需要一项大型国际多中心研究来进一步调查这个问题。本综述中纳入的唯一研究发表于2005年，截至2017年3月我们尚未发现任何进一步的相关研究。因此，在有新研究发表之前，我们不打算更新本综述。
