支气管镜指导的抗菌疗法用于囊性纤维化
Kamini Jain1, Claire E Wainwright2, Alan R Smyth3
1Leicester Children's Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
The Cochrane database of systematic reviews
|May 3, 2024
概括
对囊性纤维化 (CF) 肺部感染进行支气管镜引导的抗菌疗法在幼儿中没有显著的益处,而不是标准护理. 这种方法没有改善肺功能或生活质量,观察到类似的感染率.
科学领域:
- 肺部医学 肺部医学
- 传染性疾病 传染性疾病
- 儿科 儿科 儿科
- 囊性纤维化研究 囊性纤维化研究
背景情况:
- 早期诊断和治疗下呼吸道感染对于管理囊性纤维化 (CF) 肺病至关重要.
- 当唾液无法获得时,经常使用口腔菌培养,但它们在识别下呼吸道生物的敏感性受到质疑.
- 支气管支气管洗 (BAL) 带支气管支气管镜术提供直接访问下呼吸道样本,可能提高诊断准确性和抗菌药物选择.
研究的目的:
- 评估支气管镜指导 (或指导) 抗微生物治疗在儿童和成人囊性纤维化患者的肺部感染管理中的疗效.
- 以支气管镜程序为指导的抗菌治疗结果与以其他采样方法为指导的抗菌治疗结果进行比较.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析,将支气管镜引导的抗菌疗法与CF患者的标准护理进行比较.
- 搜索了科克伦囊性纤维化试验注册和其他数据库,截至2023年11月1日.
- 包括两项涉及CF儿童的RCT,评估肺功能,CT得分,营养状况和生活质量等结果.
主要成果:
- 在两年或五年内,在BAL导向治疗和标准护理之间没有观察到肺功能 (FEV1,LCI) 或CT评估胸部得分的显著差异.
- BAL导向治疗对营养参数或Pseudomonas aeruginosa感染率没有显著影响,但可能会增加住院治疗.
- 两种治疗方法之间的与健康有关的生活质量和感染根除率是可比的;像咳这样的轻微不良事件在手术后很常见.
结论:
- 目前来自两个RCT的证据不支持常规使用支气管支气管洗 (BAL) 来诊断和管理患有CF的学龄前儿童的肺部感染.
- 标准实践,依赖于口培养和临床症状,在这个人群中似乎与BAL引导治疗一样有效.
- 没有证据表明BAL导向治疗在成年CF患者中的使用.
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