Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
Clin Infect Dis. 2020 May 21;70(70 Suppl 1):S20-S26. doi: 10.1093/cid/ciz1227.
Plague is a rare and severe zoonotic illness with limited empiric evidence to support treatment recommendations. We summarize treatment information for all patients with plague in the United States (US) as collected under the auspices of public health surveillance.
We reviewed use of specific antimicrobials and illness outcome among cases of plague reported from 1942-2018. Antimicrobials were a priori classified into high-efficacy (aminoglycosides, tetracyclines, fluoroquinolones, sulfonamides, and chloramphenicol) and limited-efficacy classes (all others). Logistic regression models were created to describe associations between use of specific antimicrobial classes and illness outcome while controlling for potential confounding factors.
Among 533 total reported plague cases during 1942-2018, 426 (80%) received high-efficacy antimicrobial therapy. Mortality differed significantly among those receiving high-efficacy therapy (9%) and only limited-efficacy therapy (51%). Aminoglycosides and tetracyclines were used more commonly than other classes, and their use was associated with increased odds of survival of plague. Gentamicin use was associated with higher mortality than streptomycin, and aminoglycoside use was linked to higher mortality than for tetracyclines. Fluoroquinolones have been used in treatment of >30% of patients in recent years and limited data suggest clinical effectiveness.
Most US patients with plague have received effective antimicrobials. Aminoglycosides and tetracyclines substantially improve survival of plague, and fluoroquinolones may be equally as effective, yet lack sufficient data. Early recognition and early treatment with any of these antimicrobial classes remain the most important steps to improving survival of plague.
鼠疫是一种罕见且严重的人畜共患病，治疗建议主要依赖有限的经验证据。我们总结了美国（US）公共卫生监测系统收集的所有鼠疫患者的治疗信息。
我们回顾了 1942 年至 2018 年报告的鼠疫病例中特定抗菌药物的使用情况和疾病结局。抗菌药物预先分为高效（氨基糖苷类、四环素类、氟喹诺酮类、磺胺类和氯霉素）和有限效类（其他所有类别）。创建逻辑回归模型来描述使用特定抗菌药物类别与疾病结局之间的关联，同时控制潜在的混杂因素。
在 1942 年至 2018 年期间报告的 533 例总鼠疫病例中，426 例（80%）接受了高效抗菌药物治疗。接受高效治疗的患者死亡率（9%）与仅接受有限疗效治疗的患者（51%）有显著差异。氨基糖苷类和四环素类的使用比其他类别更为常见，其使用与鼠疫患者生存率的提高相关。庆大霉素的使用与较高的死亡率相关，而链霉素的使用与较高的死亡率相关，而氨基糖苷类的使用与较高的死亡率相关。氟喹诺酮类药物在近年来治疗超过 30%的患者中得到了应用，且有限的数据表明其具有临床疗效。
大多数美国鼠疫患者都接受了有效的抗菌药物治疗。氨基糖苷类和四环素类药物显著提高了鼠疫的生存率，氟喹诺酮类药物可能同样有效，但缺乏足够的数据。早期识别和使用任何这些抗菌药物类别仍然是提高鼠疫生存率的最重要步骤。
