Casaredi Isabel Gascon, Shaw Michelle, Waters Valerie, Seeto Ryan, Blanchard Ana C, Ratjen Felix
Division of Respiratory Medicine, Department of Pediatrics, Hospital Sant Joan de Déu de Barcelona, Universidad de Barcelona, Barcelona, Spain; Division of Respiratory Medicine, Department of Paediatrics, University of Toronto, Toronto, Canada.
Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada.
J Cyst Fibros. 2023 Jan;22(1):98-102. doi: 10.1016/j.jcf.2022.08.007. Epub 2022 Aug 20.
While antibiotic eradication therapy (AET) of early Pseudomonas aeruginosa infection is considered standard of care, its long-term effect on the subsequent course of cystic fibrosis (CF) lung disease remains unclear.
CF patients who were P. aeruginosa-free for at least a year and had a minimum of 10 years of pulmonary function measurements were included. Subjects were categorized as Never if they never had P. aeruginosa isolated from a respiratory tract sample. Subjects changed to the Eradicated group if they had a P. aeruginosa infection, were treated with AET, and subsequently cleared their infection. Subjects changed to the Chronic group if AET did not clear their P. aeruginosa infection. The primary outcome was absolute FEV decline over time, with age as the time variable. Mixed-effects linear regression models were used to account for the repeated lung function measurements over time within each patient.
205 CF subjects (48% female) were included; the median (IQR) age at first infection was 9.6 (5.6, 14.6) years. The median (IQR) follow-up was 10.2 (5.7, 14.7) years for the Eradicated group, 8.8 (4.5, 14.9) years for the Chronic group and 2.8 (1.0, 5.7) years for the Never group was among those patients that had at least one P. aeruginosa infection over the study period, annual lung function decline of FEV was significantly less (-1.11% predicted/year; 95% CI: -1.18, -1.04) in the Eradication group compared to the Chronic group (-1.57%; -1.64, -1.50) (p<0.001).
AET against P. aeruginosa improves lung function trajectory in CF patients.
虽然早期铜绿假单胞菌感染的抗生素根除疗法（AET）被认为是标准治疗方法，但其对囊性纤维化（CF）肺部疾病后续病程的长期影响仍不清楚。
纳入至少一年未感染铜绿假单胞菌且有至少10年肺功能测量数据的CF患者。如果从未从呼吸道样本中分离出铜绿假单胞菌，则将受试者分类为“从未感染组”。如果受试者发生铜绿假单胞菌感染、接受AET治疗并随后清除感染，则改为“根除组”。如果AET未能清除其铜绿假单胞菌感染，则受试者改为“慢性感染组”。主要结局是随着时间推移FEV的绝对下降，以年龄作为时间变量。使用混合效应线性回归模型来考虑每位患者随时间重复的肺功能测量数据。
纳入205名CF受试者（48%为女性）；首次感染时的中位（IQR）年龄为9.6（5.6，14.6）岁。“根除组”的中位（IQR）随访时间为10.2（5.7，14.7）年，“慢性感染组”为8.8（4.5，14.9）年，“从未感染组”为2.8（1.0，5.7）年。在研究期间至少有一次铜绿假单胞菌感染的患者中，“根除组”的FEV年度肺功能下降明显低于“慢性感染组”（预测值每年下降-1.11%；95%CI：-1.18，-1.04），“慢性感染组”为-1.57%（-1.64，-1.50）（p<0.001）。
针对铜绿假单胞菌的AET可改善CF患者的肺功能轨迹。
