治疗囊性纤维化肺部加重症时使用抗厌氧菌抗生素的疗效。

Outcomes of cystic fibrosis pulmonary exacerbations treated with antibiotics with activity against anaerobic bacteria.

机构信息

Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.

Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI, USA.

出版信息

J Cyst Fibros. 2021 Nov;20(6):926-931. doi: 10.1016/j.jcf.2021.02.001. Epub 2021 Feb 19.

DOI:10.1016/j.jcf.2021.02.001

PMID:33612403

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8371065/

Abstract

BACKGROUND

Obligate and facultative anaerobic bacteria are prevalent in cystic fibrosis (CF) airways. Increases in anaerobe relative abundance have been associated with CF pulmonary exacerbations (PEx); however, the impact of antibiotic treatment of anaerobes during PEx is unknown. We hypothesized that PEx treated with antibiotics with activity against anaerobes would improve outcomes compared to antibiotics without anaerobic activity.

METHODS

This was a single-center, retrospective study of people with CF, ages 6 years and older, treated with intravenous (IV) antibiotics for PEx. IV antibiotics were classified as either broad or minimal anaerobic activity. PEx treated with broad anaerobe coverage were propensity-score matched to PEx treated with minimal anaerobic coverage. The primary outcome, % of baseline % predicted forced expiratory volume in one second (ppFEV) recovered, was compared between antibiotic categories with a linear mixed model. The secondary outcome, time to next PEx, was assessed using a Prentice Williams Petersen model.

RESULTS

514 PEx from 182 patients were included. Broad anaerobe coverage was used in 27% of PEx, and was used more often for older patients (p < 0.001) with worse baseline ppFEV (p < 0.001), and with Achromobacter (p < 0.001) or Burkholderia infections (p = 0.002). In the matched PEx, broad anaerobe coverage was not a significant predictor of % of baseline ppFEV recovered (∆ppFEV = -2.4, p = 0.09). Broad anaerobe coverage was also not a significant predictor of time to next PEx (HR 0.89, 95% CI 0.7-1.13, p = 0.35).

CONCLUSIONS

In this single center, retrospective study, antibiotics with broad activity against anaerobes were not associated with improved outcomes of CF PEx.

摘要

背景

需氧和兼性厌氧菌在囊性纤维化（CF）气道中很常见。厌氧菌相对丰度的增加与 CF 肺部恶化（PEx）有关；然而，在 PEx 期间用抗生素治疗厌氧菌的影响尚不清楚。我们假设用对厌氧菌有活性的抗生素治疗 PEx 会比用没有厌氧菌活性的抗生素治疗效果更好。

方法

这是一项针对年龄在 6 岁及以上的 CF 患者的单中心、回顾性研究，他们因 PEx 接受了静脉（IV）抗生素治疗。IV 抗生素分为广谱或最小厌氧活性。用广谱厌氧菌覆盖治疗的 PEx 与用最小厌氧菌覆盖治疗的 PEx 进行倾向评分匹配。主要结局指标，即恢复的基线预测用力呼气量（ppFEV）的百分比，用线性混合模型在抗生素类别之间进行比较。次要结局指标，即下一次 PEx 的时间，使用 Prentice Williams Petersen 模型进行评估。

结果

共纳入 182 例患者的 514 次 PEx。27%的 PEx 使用了广谱厌氧菌覆盖，且更常用于年龄较大（p<0.001）、基线 ppFEV 较差（p<0.001）、以及患有不动杆菌（p<0.001）或伯克霍尔德菌感染（p=0.002）的患者。在匹配的 PEx 中，广谱厌氧菌覆盖不是恢复的基线 ppFEV 的百分比的显著预测因素（∆ppFEV=-2.4，p=0.09）。广谱厌氧菌覆盖也不是下一次 PEx 时间的显著预测因素（HR 0.89，95%CI 0.7-1.13，p=0.35）。