Nelson Christina A, Fleck-Derderian Shannon, Cooley Katharine M, Meaney-Delman Dana, Becksted Heidi A, Russell Zachary, Renaud Bertrand, Bertherat Eric, Mead Paul S
Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Fellowship Program, Oak Ridge, Tennessee, USA.
Clin Infect Dis. 2020 May 21;70(70 Suppl 1):S3-S10. doi: 10.1093/cid/ciz1226.
Yersinia pestis remains endemic in Africa, Asia, and the Americas and is a known bioterrorism agent. Treatment with aminoglycosides such as streptomycin or gentamicin is effective when initiated early in illness but can have serious side effects. Alternatives such as fluoroquinolones, tetracyclines, and sulfonamides are potentially safer but lack robust human data on efficacy.
We searched PubMed Central, Medline, Embase, and other databases for articles in any language with terms related to plague and antimicrobials. Articles that contained case-level information on antimicrobial treatment and patient outcome were included. We abstracted information related to patient demographics, clinical features, treatment, and fatality.
Among 5837 articles screened, we found 762 published cases of treated plague reported from 1937 to 2019. Fifty-nine percent were male; median age was 22 years (range, 8 days-80 years). The case fatality rate was 20% overall. Most patients had primary bubonic (63%), pneumonic (21%), or septicemic (5%) plague, with associated case fatality rates of 17%, 27%, and 38%, respectively. Among those treated with an aminoglycoside (n = 407 [53%]), the case fatality rate was 13%. Among those treated with a sulfonamide (n = 322 [42%]), tetracycline (n = 171 [22%]), or fluoroquinolone (n = 61 [8%]), fatality was 23%, 10%, and 12%, respectively. Case fatality rate did not substantially differ between patients treated with 1 vs 2 classes of antimicrobials considered to be effective for plague.
In addition to aminoglycosides, other classes of antimicrobials including tetracyclines, fluoroquinolones, and sulfonamides are effective for plague treatment, although publication bias and low numbers in certain treatment groups may limit interpretation.
鼠疫耶尔森菌在非洲、亚洲和美洲仍然是地方病，并且是一种已知的生物恐怖主义制剂。在疾病早期开始使用链霉素或庆大霉素等氨基糖苷类药物治疗是有效的，但可能会有严重的副作用。氟喹诺酮类、四环素类和磺胺类等替代药物可能更安全，但缺乏关于疗效的有力人体数据。
我们在PubMed Central、Medline、Embase和其他数据库中搜索了任何语言的与鼠疫和抗菌药物相关的文章。纳入包含抗菌治疗和患者结局的病例水平信息的文章。我们提取了与患者人口统计学、临床特征、治疗和死亡率相关的信息。
在筛选的5837篇文章中，我们发现了1937年至2019年报告的762例经治疗的鼠疫病例。59%为男性；中位年龄为22岁（范围8天至80岁）。总体病死率为20%。大多数患者患有原发性腺鼠疫（63%）、肺鼠疫（21%）或败血型鼠疫（5%），相关病死率分别为17%、27%和38%。在接受氨基糖苷类药物治疗的患者中（n = 407 [53%]），病死率为13%。在接受磺胺类药物治疗的患者中（n = 322 [42%]）、四环素类药物治疗的患者中（n = 171 [22%]）或氟喹诺酮类药物治疗的患者中（n = 61 [8%]），病死率分别为23%、10%和12%。接受1类与2类被认为对鼠疫有效的抗菌药物治疗的患者之间病死率没有实质性差异。
除氨基糖苷类药物外，包括四环素类、氟喹诺酮类和磺胺类在内的其他类抗菌药物对鼠疫治疗有效，尽管发表偏倚和某些治疗组的病例数较少可能会限制解释。
