在囊性纤维化期间抗生素治疗方案的变化儿科肺部恶化治疗
Jonathan D Cogen1, Don B Sanders2, James E Slaven3
1Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Annals of the American Thoracic Society
|June 16, 2023
概括
在囊性纤维化肺部恶化期间改变静脉注射抗生素是常见的,但不会改善结果. 这种做法与更好的肺功能恢复或减少儿童未来恶化并无关联.
科学领域:
- 儿科肺病学 儿科肺病学
- 传染性疾病 传染性疾病
- 临床药房 临床药房
背景情况:
- 对于囊性纤维化 (CF) 肺恶化 (PEx) 的抗生素选择通常依赖于先前的培养结果或治疗方法.
- 在PEx期间改变抗生素治疗方案的临床益处尚未得到充分证实.
- 当前的做法经常涉及改变抗生素,如果初始治疗未能改善症状或肺功能.
研究的目的:
- 评估与在PEx期间改变静脉注射抗生素相关的临床结果,在患有CF的儿童.
- 确定抗生素修改是否影响肺功能恢复和未来恶化的风险.
主要方法:
- 使用囊性纤维化基金会患者登记册儿科健康信息系统进行的回顾性队列研究.
- 包括6至21岁的患有CF的儿童,经历了用静脉注射抗生素治疗的PEx (2006-2018).
- 定义的抗生素变化是6日和出院之间的修改;用于偏差调整的治疗权重的逆概率.
主要成果:
- 分析了超过18,000个PEx;43.6%涉及抗生素变化.
- 抗生素变化与1秒内预测的百分比强迫呼气量 (ppFEV1) 的改善恢复无关.
- 与抗生素变化的PEx显示未来PEx的几率增加 (OR, 1.17).
结论:
- 在患有CF的儿童中,在PEx期间更换静脉注射的抗生素是常见的做法.
- 这一策略与改善的临床结果没有联系,包括肺功能恢复.
- 这些发现表明,在PEx期间对抗生素的修改可能没有益处,并且可能与未来恶化的增加有关.
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