Waters Valerie, Ratjen Felix
Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada.
Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
Cochrane Database Syst Rev. 2020 Jun 10;6(6):CD010004. doi: 10.1002/14651858.CD010004.pub5.
Nontuberculous mycobacteria are mycobacteria, other than those in the Mycobacterium tuberculosis complex, and are commonly found in the environment. Nontuberculous mycobacteria species (most commonly Mycobacterium avium complex and Mycobacterium abscessus) are isolated from the respiratory tract of approximately 5% to 40% of individuals with cystic fibrosis; they can cause lung disease in people with cystic fibrosis leading to more a rapid decline in lung function and even death in certain circumstances. Although there are guidelines for the antimicrobial treatment of nontuberculous mycobacteria lung disease, these recommendations are not specific for people with cystic fibrosis and it is not clear which antibiotic regimen may be the most effective in the treatment of these individuals. This is an update of a previous review.
The objective of our review was to compare antibiotic treatment to no antibiotic treatment, or to compare different combinations of antibiotic treatment, for nontuberculous mycobacteria lung infections in people with cystic fibrosis. The primary objective was to assess the effect of treatment on lung function and pulmonary exacerbations and to quantify adverse events. The secondary objectives were to assess treatment effects on the amount of bacteria in the sputum, quality of life, mortality, nutritional parameters, hospitalizations and use of oral antibiotics.
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search: 24 February 2020. We also searched a register of ongoing trials and the reference lists of relevant articles and reviews. Date of last search: 21 March 2019.
Any randomized controlled trials comparing nontuberculous mycobacteria antibiotics to no antibiotic treatment, as well as one nontuberculous mycobacteria antibiotic regimen compared to another nontuberculous mycobacteria antibiotic regimen, in individuals with cystic fibrosis. DATA COLLECTION AND ANALYSIS: Data were not collected because in the one trial identified by the search, data specific to individuals with cystic fibrosis could not be obtained from the pharmaceutical company.
One completed trial was identified by the searches, but data specific to individuals with cystic fibrosis could not be obtained from the pharmaceutical company.
AUTHORS' CONCLUSIONS: This review did not find any evidence for the effectiveness of different antimicrobial treatment for nontuberculous mycobacteria lung disease in people with cystic fibrosis. Until such evidence becomes available, it is reasonable for clinicians to follow published clinical practice guidelines for the diagnosis and treatment of nodular or bronchiectatic pulmonary disease due to Mycobacterium avium complex or Mycobacterium abscessus in patients with cystic fibrosis.
非结核分枝杆菌是指除结核分枝杆菌复合群之外的分枝杆菌，常见于环境中。非结核分枝杆菌菌种（最常见的是鸟分枝杆菌复合群和脓肿分枝杆菌）在约5%至40%的囊性纤维化患者呼吸道中被分离出来；它们可导致囊性纤维化患者发生肺部疾病，导致肺功能更快下降，在某些情况下甚至死亡。尽管有非结核分枝杆菌肺病的抗菌治疗指南，但这些建议并非针对囊性纤维化患者，目前尚不清楚哪种抗生素方案可能对治疗这些患者最有效。这是对先前一篇综述的更新。
我们综述的目的是比较抗生素治疗与不进行抗生素治疗，或比较不同抗生素治疗组合，用于囊性纤维化患者的非结核分枝杆菌肺部感染。主要目的是评估治疗对肺功能和肺部加重的影响，并量化不良事件。次要目的是评估治疗对痰液中细菌数量、生活质量、死亡率、营养参数、住院情况和口服抗生素使用的影响。
我们检索了Cochrane囊性纤维化试验注册库，该注册库通过电子数据库检索以及对期刊和会议摘要书籍的手工检索汇编而成。最后一次检索日期：2020年2月24日。我们还检索了正在进行的试验注册库以及相关文章和综述的参考文献列表。最后一次检索日期：2019年3月21日。
任何比较非结核分枝杆菌抗生素与不进行抗生素治疗，以及一种非结核分枝杆菌抗生素方案与另一种非结核分枝杆菌抗生素方案的随机对照试验，受试者为囊性纤维化患者。
未收集数据，因为在检索到的一项试验中，无法从制药公司获得特定于囊性纤维化患者的数据。
检索到一项已完成试验，但无法从制药公司获得特定于囊性纤维化患者的数据。
本综述未发现任何证据表明不同抗菌治疗对囊性纤维化患者的非结核分枝杆菌肺病有效。在获得此类证据之前，临床医生遵循已发表的关于囊性纤维化患者因鸟分枝杆菌复合群或脓肿分枝杆菌引起的结节性或支气管扩张性肺病的诊断和治疗的临床实践指南是合理的。
