抗假单胞菌抗生素治疗强度与囊性纤维化儿童新获得铜绿假单胞菌后治疗出现的病原体风险的关联。

Association of Intensity of Antipseudomonal Antibiotic Therapy With Risk of Treatment-Emergent Organisms in Children With Cystic Fibrosis and Newly Acquired Pseudomonas Aeruginosa.

机构信息

Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.

Seattle Children's Research Institute, Seattle, Washington, USA.

出版信息

Clin Infect Dis. 2021 Sep 15;73(6):987-993. doi: 10.1093/cid/ciab208.

DOI:10.1093/cid/ciab208

PMID:33693586

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9034203/

Abstract

BACKGROUND

While Pseudomonas aeruginosa (Pa) eradication regimens have contributed to a decline in Pa prevalence in people with cystic fibrosis (CF), this antibiotic exposure might increase the risk of acquisition of drug-resistant organisms. This study evaluated the association between antipseudomonal antibiotic exposure intensity and acquisition risk of drug-resistant organisms among children with CF and new Pa infection.

METHODS

We utilized data from the Early Pseudomonas Infection Control Clinical Trial (EPIC CT), a randomized controlled trial comparing Pa eradication strategies in children with CF and new Pa. The exposure was the number of weeks of oral or inhaled antipseudomonal antibiotics or ever versus never treatment with intravenous antipseudomonal antibiotics during the 18 months of EPIC CT participation. Primary outcomes were risks of acquisition of several respiratory organisms during 5 years of follow-up after EPIC CT estimated using Cox proportional hazards models separately for each specific organism.

RESULTS

Among 249 participants, there was no increased acquisition risk of any organism associated with greater inhaled antibiotic exposure. With each additional week of oral antibiotics, there was an increased hazard of Achromobacter xylosoxidans acquisition (HR, 1.24; 95% CI: 1.02-1.50; P = .03). Treatment with intravenous antibiotics was associated with an increased hazard of acquisition of multidrug-resistant Pa (HR, 2.47; 95% CI: 1.28-4.78; P = .01) and MRSA (HR, 1.57; 95% CI: 1.03-2.40; P = .04).

CONCLUSIONS

Results from this study illustrate the importance of making careful antibiotic choices to balance the benefits of antibiotics in people with CF while minimizing risk of acquisition of drug-resistant organisms.

摘要

背景

虽然铜绿假单胞菌（Pa）消除方案有助于降低囊性纤维化（CF）患者的 Pa 流行率，但这种抗生素暴露可能会增加获得耐药生物体的风险。本研究评估了在 CF 患儿中，与 Pa 新感染相关的抗假单胞菌抗生素暴露强度与获得耐药生物体的风险之间的关联。

方法

我们利用来自早期铜绿假单胞菌感染控制临床试验（EPIC CT）的数据，这是一项比较 CF 患儿 Pa 消除策略的随机对照试验。暴露是指在 EPIC CT 参与的 18 个月期间，口服或吸入性抗假单胞菌抗生素的周数，或静脉用抗假单胞菌抗生素的治疗次数。主要结局是使用 Cox 比例风险模型分别为每种特定生物体在 EPIC CT 后 5 年的随访期间获得几种呼吸道生物体的风险。

结果

在 249 名参与者中，吸入抗生素暴露量增加与任何生物体的获得风险增加无关。口服抗生素每增加一周，Achromobacter xylosoxidans 的获得风险增加（HR，1.24；95%CI：1.02-1.50；P=0.03）。静脉用抗生素治疗与获得耐多药 Pa（HR，2.47；95%CI：1.28-4.78；P=0.01）和耐甲氧西林金黄色葡萄球菌（MRSA）（HR，1.57；95%CI：1.03-2.40；P=0.04）的风险增加相关。