Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Division of Pediatric Pulmonology, Allergy and Sleep Medicine, and.
Ann Am Thorac Soc. 2023 Sep;20(9):1293-1298. doi: 10.1513/AnnalsATS.202301-078OC.
Antibiotic selection for in-hospital treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) is typically guided by previous respiratory culture results or past PEx antibiotic treatment. In the absence of clinical improvement during PEx treatment, antibiotics are frequently changed in search of a regimen that better alleviates symptoms and restores lung function. The clinical benefits of changing antibiotics during PEx treatment are largely uncharacterized. This was a retrospective cohort study using the Cystic Fibrosis Foundation Patient Registry Pediatric Health Information System. PEx were included if they occurred in children with CF from 6 to 21 years old who had been treated with intravenous antibiotics between January 1, 2006, and December 31, 2018. PEx with lengths of stay <5 or >21 days or for which treatment was delivered in an intensive care unit were excluded. An antibiotic change was defined as the addition or subtraction of any intravenous antibiotic between Hospital Day 6 and the day before hospital discharge. Inverse probability of treatment weighting was used to adjust for disease severity and indication bias, which might influence a decision to change antibiotics. In all, 4,099 children with CF contributed 18,745 PEx for analysis, of which 8,169 PEx (43.6%) included a change in intravenous antibiotics on or after Hospital Day 6. The mean change in pre- to post-treatment percent predicted forced expiratory volume in 1 second (ppFEV) was 11.3 (standard error, 0.21) among events in which an intravenous antibiotic change occurred versus 12.2 (0.18) among PEx without an intravenous antibiotic change ( = 0.001). Similarly, the odds of return to ⩾90% of baseline ppFEV were less for PEx with antibiotic changes than for those without changes (odds ratio [OR], 0.89 [95% confidence interval (CI), 0.80-0.98]). The odds of returning to ⩾100% of baseline ppFEV did not differ between PEx with versus without antibiotic changes (OR, 0.94 [95% CI, 0.86-1.03]). In addition, PEx treated with intravenous antibiotic changes were associated with higher odds of future PEx (OR, 1.17 [95% CI, 1.12-1.22]). In this retrospective study, changing intravenous antibiotics during PEx treatment in children with CF was common and not associated with improved clinical outcomes.
在医院治疗囊性纤维化 (CF) 患者的肺部恶化 (PEx) 时，抗生素的选择通常根据之前的呼吸道培养结果或过去的 PEx 抗生素治疗情况来指导。如果在 PEx 治疗过程中没有临床改善，通常会更换抗生素，以寻找一种能更好缓解症状和恢复肺功能的方案。在 PEx 治疗过程中更换抗生素的临床益处在很大程度上还没有被描述。
这是一项使用囊性纤维化基金会患者注册儿科健康信息系统的回顾性队列研究。纳入标准为年龄在 6 至 21 岁之间的 CF 患儿，在 2006 年 1 月 1 日至 2018 年 12 月 31 日期间接受过静脉抗生素治疗，且 PEx 的住院时间 <5 或 >21 天或在重症监护病房接受治疗。抗生素变化定义为在住院第 6 天至出院前一天之间添加或减去任何静脉抗生素。使用逆概率治疗加权法来调整疾病严重程度和治疗指示偏倚，这些因素可能会影响抗生素更换的决策。
共有 4099 名 CF 患儿为 18745 例 PEx 做出贡献，其中 8169 例 (43.6%)在住院第 6 天或之后的静脉抗生素治疗中发生了抗生素变化。在发生抗生素变化的事件中，治疗前后预测的 1 秒用力呼气量百分比 (ppFEV) 的变化平均值为 11.3(标准误差，0.21)，而无静脉抗生素变化的 PEx 为 12.2(0.18) ( = 0.001)。同样，与无抗生素变化的 PEx 相比，有抗生素变化的 PEx 恢复到 ⩾90%基线 ppFEV 的几率较低 (比值比 [OR]，0.89 [95%置信区间 (CI)，0.80-0.98])。有抗生素变化的 PEx 与无抗生素变化的 PEx 相比，恢复到 ⩾100%基线 ppFEV 的几率没有差异 (OR，0.94 [95% CI，0.86-1.03])。此外，在 CF 患儿中，静脉抗生素治疗的 PEx 与更高的未来 PEx 几率相关 (OR，1.17 [95% CI，1.12-1.22])。
在这项回顾性研究中，在 CF 患儿的 PEx 治疗过程中更换静脉抗生素很常见，但与改善临床结局无关。
