CRCM pédiatrique, Service de Pneumo-Allergologie pédiatrique, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, 330 avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France.
Service de Bactériologie-Hygiène, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
BMC Pulm Med. 2020 Jun 5;20(1):159. doi: 10.1186/s12890-020-01190-y.
Whereas Burkholderia infections are recognized to impair prognosis in cystic fibrosis (CF) patients, there is no recommendation to date for early eradication therapy. The aim of our study was to analyse the current management of initial colonisations with Burkholderia cepacia complex (BCC) or B. gladioli in French CF Centres and its impact on bacterial clearance and clinical outcome.
We performed a retrospective review of the primary colonisations (PC), defined as newly positive sputum cultures, observed between 2010 and 2018 in five CF Centres. Treatment regimens, microbiological and clinical data were collected.
Seventeen patients (14 with BCC, and 3 with B. gladioli) were included. Eradication therapy, using heterogeneous combinations of intravenous, oral or nebulised antibiotics, was attempted in 11 patients. Six out of the 11 treated patients, and 4 out of the 6 untreated patients cleared the bacterium. Though not statistically significant, higher forced expiratory volume in 1 second and forced vital capacity at PC and consistency of treatment with in vitro antibiotic susceptibility tended to be associated with eradication. The management of PC was shown to be heterogeneous, thus impairing the statistical power of our study. Large prospective studies are needed to define whom to treat, when, and how.
Pending these studies, we propose, due to possible spontaneous clearance, to check the presence of Burkholderia 1 month after PC before starting antibiotics, at least in the milder cases, and to evaluate a combination of intravenous beta-lactam + oral or intravenous fluoroquinolone + inhaled aminoglycoside.
虽然布氏杆菌感染被认为会影响囊性纤维化（CF）患者的预后，但目前尚无早期清除治疗的建议。我们的研究目的是分析法国 CF 中心目前对伯克霍尔德氏菌复合群（BCC）或 B. gladioli 初始定植的管理方法，及其对细菌清除和临床结局的影响。
我们回顾性分析了 2010 年至 2018 年间在五个 CF 中心观察到的首次定植（PC），定义为新的阳性痰培养。收集了治疗方案、微生物学和临床数据。
17 名患者（14 名 BCC，3 名 B. gladioli）被纳入研究。11 名患者尝试了使用静脉、口服或雾化抗生素的不同组合进行清除治疗。在 11 名接受治疗的患者中，有 6 名清除了细菌，而在未接受治疗的 6 名患者中，有 4 名清除了细菌。虽然没有统计学意义，但更高的 1 秒用力呼气量和用力肺活量在 PC 时以及治疗的一致性与清除细菌有关。PC 的管理存在异质性，从而降低了我们研究的统计效力。需要进行大型前瞻性研究，以确定治疗对象、时间和方法。
在这些研究进行之前，我们建议在首次定植后 1 个月，在开始使用抗生素之前，检查是否存在伯克霍尔德菌，至少在轻度病例中是这样，并且评估静脉内β-内酰胺+口服或静脉内氟喹诺酮+吸入氨基糖苷类药物的联合治疗。
