Division of Paediatric Medicine, Department Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8, Canada.
Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
J Cyst Fibros. 2022 Sep;21(5):759-765. doi: 10.1016/j.jcf.2022.05.010. Epub 2022 May 30.
Antibiotics are often changed during treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) who have a poor clinical response. We aimed to characterize the reasons CF providers change antibiotics and examined the effects of antibiotic changes on lung function recovery.
This was a retrospective cohort study using the Toronto CF Database from 2009 to 2015 of adults and children with CF PEx treated with intravenous antibiotics. The co-primary outcome measure was absolute and relative change in forced expiratory lung volume in 1 s (FEV) at end of treatment and follow-up. Secondary outcome assessed the proportion of patients returning to > 90% or > 100% previous baseline FEV.
A total of 399 PEx were included of which 105 had antibiotic changes. Reasons for antibiotic changes included change in antibiotic route prior to discharge (26%), drug reactions (20%), poor FEV response (25%), targeting additional microbes (16%) and lack of symptom improvement (13%). In our multivariable analysis, among non-responders (< 90% FEV recovery to baseline or lack of symptom improvement at the interim time point), a change in antibiotics was not associated with any significant difference in absolute or relative FEV at end of treatment or at follow-up. Antibiotic change in non-responders was not associated with improved return to 90% or 100% baseline FEV at end of treatment or follow-up.
Changing antibiotics during CF PEx treatment in those with poor clinical response was not associated with any improved FEV response or return to baseline lung function.
在囊性纤维化 (CF) 患者肺部恶化 (PEx) 治疗过程中，如果临床反应不佳，经常会改变抗生素。我们旨在描述 CF 提供者改变抗生素的原因，并研究抗生素变化对肺功能恢复的影响。
这是一项回顾性队列研究，使用了 2009 年至 2015 年多伦多 CF 数据库，纳入 CF 患者 PEx 静脉内抗生素治疗。主要终点是治疗结束和随访时 1 秒用力呼气量 (FEV) 的绝对和相对变化。次要终点评估恢复 > 90%或> 100% 先前基线 FEV 的患者比例。
共纳入 399 例 PEx，其中 105 例发生抗生素改变。抗生素改变的原因包括出院前改变抗生素途径 (26%)、药物反应 (20%)、FEV 反应不佳 (25%)、针对其他微生物 (16%)和症状改善不佳 (13%)。在多变量分析中，在无反应者（FEV 恢复至基线的<90%或在中间时间点无症状改善）中，抗生素改变与治疗结束或随访时 FEV 的绝对值或相对值均无显著差异。无反应者的抗生素改变与治疗结束或随访时恢复至 90%或 100%基线 FEV 无关。
在临床反应不佳的 CF PEx 治疗中改变抗生素与 FEV 反应或恢复至基线肺功能无关。
