Division of Pulmonary & Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States.
Children's Hospital Association, Lenexa, Kansas, United States.
J Cyst Fibros. 2023 Mar;22(2):313-319. doi: 10.1016/j.jcf.2022.08.001. Epub 2022 Aug 7.
Limited data exist to inform antibiotic selection among people with cystic fibrosis (CF) with airway infection by multiple CF-related microorganisms. This study aimed to determine among children with CF co-infected with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (Pa) if the addition of anti-MRSA antibiotics to antipseudomonal antibiotic treatment for pulmonary exacerbations (PEx) would be associated with improved clinical outcomes compared with antipseudomonal antibiotics alone.
Retrospective cohort study using data from the CF Foundation Patient Registry-Pediatric Health Information System linked dataset. The odds of returning to baseline lung function and having a subsequent PEx requiring intravenous antibiotics were compared between PEx treated with anti-MRSA and antipseudomonal antibiotics and those treated with antipseudomonal antibiotics alone, adjusting for confounding by indication using inverse probability of treatment weighting.
943 children with CF co-infected with MRSA and Pa contributed 2,989 PEx for analysis. Of these, 2,331 (78%) PEx were treated with both anti-MRSA and antipseudomonal antibiotics and 658 (22%) PEx were treated with antipseudomonal antibiotics alone. Compared with PEx treated with antipseudomonal antibiotics alone, the addition of anti-MRSA antibiotics to antipseudomonal antibiotic therapy was not associated with a higher odds of returning to ≥90% or ≥100% of baseline lung function or a lower odds of future PEx requiring intravenous antibiotics.
Children with CF co-infected with MRSA and Pa may not benefit from the addition of anti-MRSA antibiotics for PEx treatment. Prospective studies evaluating optimal antibiotic selection strategies for PEx treatment are needed to optimize clinical outcomes following PEx treatment.
在患有囊性纤维化（CF）且气道感染多种 CF 相关微生物的人群中，用于指导抗生素选择的数据有限。本研究旨在确定合并耐甲氧西林金黄色葡萄球菌（MRSA）和铜绿假单胞菌（Pa）感染的 CF 患儿，如果在治疗肺部感染加重（PEx）时加用抗 MRSA 抗生素与仅用抗假单胞菌抗生素相比，是否会改善临床结局。
使用 CF 基金会患者登记处-儿科健康信息系统链接数据集进行回顾性队列研究。使用逆概率治疗加权法，通过倾向性评分调整混杂因素，比较抗 MRSA 与抗假单胞菌抗生素联合治疗与仅用抗假单胞菌抗生素治疗的 PEx 患儿恢复至基线肺功能和随后需要静脉使用抗生素的 PEx 的可能性。
943 名合并 MRSA 和 Pa 感染的 CF 患儿共发生 2989 次 PEx，其中 2331 次（78%）PEx 接受了抗 MRSA 和抗假单胞菌抗生素联合治疗，658 次（22%）PEx 仅接受了抗假单胞菌抗生素治疗。与仅用抗假单胞菌抗生素治疗的 PEx 相比，抗 MRSA 抗生素联合抗假单胞菌抗生素治疗并未增加 PEx 患儿恢复至≥90%或≥100%基线肺功能的可能性，也未降低未来需要静脉使用抗生素的 PEx 的可能性。
合并 MRSA 和 Pa 感染的 CF 患儿可能不会从 PEx 治疗中加用抗 MRSA 抗生素中获益。需要开展前瞻性研究来评估 PEx 治疗的最佳抗生素选择策略，以优化 PEx 治疗后的临床结局。
