Department of Pediatric Pulmonology, Selim Coremen Cystic Fibrosis Center, Marmara University Faculty of Medicine, Istanbul, Turkey.
Faculty of Medicine, Marmara University, Istanbul, Turkey.
Pediatr Pulmonol. 2021 Dec;56(12):3745-3751. doi: 10.1002/ppul.25646. Epub 2021 Sep 9.
Chronic pulmonary infection is the leading cause of mortality and morbidity in patients with cystic fibrosis (CF). The most common pathogens isolated in CF are Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA). Chronic infection of PA and methicillin-resistant S. aureus (MRSA) are associated with worse survival and antibiotic eradication treatment is recommended for both. This study compared the outcomes between intravenous (IV) and non-IV antibiotics in eradication of PA and MRSA.
This was a single-center retrospective study. All respiratory specimen cultures of 309 CF patients and eradication regimens between 2015 and 2019 were reviewed. Patients received eradication treatment in case of first ever isolation or new isolation after being infection-free ≥1 year. The primary analysis was the comparison of the percentage of successful eradication after receiving IV and non-IV eradication regimens. Demographic and clinical risk factors for eradication failure were also analyzed.
One hundred and two patients with PA isolations and 48 patients with MRSA were analyzed. At 1 year, 21.6% in PA group and 35.4% in MRSA group were successfully eradicated. There was not any statistically significant difference between IV versus non-IV antibiotic regimens on eradication in either group. Additionally, none of the clinical risk factors was significantly associated with eradication failure in PA and MRSA groups.
In the eradication of PA and MRSA, IV and non-IV treatment regimens did not show any superiority to one another. Non-parenteral eradication could be a better option considering the cost-effectiveness and the treatment burden of IV treatments due to hospitalization and the need for IV access.
慢性肺部感染是囊性纤维化（CF）患者死亡和发病的主要原因。CF 中最常见的分离病原体是金黄色葡萄球菌（SA）和铜绿假单胞菌（PA）。PA 和耐甲氧西林金黄色葡萄球菌（MRSA）的慢性感染与更差的生存相关，因此建议对两者均进行抗生素清除治疗。本研究比较了 PA 和 MRSA 清除治疗中静脉（IV）和非-IV 抗生素的结局。
这是一项单中心回顾性研究。回顾了 2015 年至 2019 年间 309 例 CF 患者的所有呼吸道标本培养物和清除方案。患者在首次分离或在无感染≥1 年后新分离时接受清除治疗。主要分析是接受 IV 和非-IV 清除方案后成功清除的百分比比较。还分析了清除失败的人口统计学和临床危险因素。
分析了 102 例 PA 分离患者和 48 例 MRSA 分离患者。在 1 年时，PA 组中有 21.6%，MRSA 组中有 35.4%成功清除。在 PA 和 MRSA 两组中，IV 与非-IV 抗生素方案在清除方面均无统计学差异。此外，在 PA 和 MRSA 组中，没有任何临床危险因素与清除失败显著相关。
在 PA 和 MRSA 的清除中，IV 和非-IV 治疗方案彼此之间没有显示出任何优势。考虑到 IV 治疗的成本效益和治疗负担（包括住院和静脉通路的需求），非肠道清除可能是更好的选择。
