Cystic Fibrosis Foundation pulmonary guideline. pharmacologic approaches to prevention and eradication of initial Pseudomonas aeruginosa infection.
Cystic Fibrosis Foundation pulmonary guideline. pharmacologic approaches to prevention and eradication of initial Pseudomonas aeruginosa infection.
复制标题
DOI：
10.1513/annalsats.201404-166oc
复制
发表时间：
2014-12-01
影响因子：
8.3
通讯作者：
Marshall, Bruce C
中科院分区：
文献类型：
--
作者：
Mogayzel, Peter J Jr;Naureckas, Edward T;Marshall, Bruce C
产品说明：囊性纤维化（CF）基金会制定了临床护理指南，用于预防铜绿假单胞菌感染，治疗初始铜绿假单胞菌感染，并使用支气管镜检查，以获得常规的气道文化在个人与CF。方法：一个多学科委员会制定了关于预防和治疗初始铜绿假单胞菌感染和使用支气管镜检查，以获得常规的气道文化的问题。关注的结果指标是无铜绿假单胞菌生长的培养物。在2012年5月和2013年8月对PubMed、EMBASE和科克伦对照试验中心注册库进行了系统性综述。将CF的受控词汇和文本词汇以及与每个问题相关的术语合并。整个委员会审查了证据，并使用美国预防服务工作组系统对最终建议声明进行了评级。建议一：CF基金会强烈建议吸入性抗生素治疗气道培养物中铜绿假单胞菌的初始或新生长（净效益的确定性，高;净效益的估计，实质性;推荐等级，A）。首选的抗生素方案是吸入妥布霉素（300 mg，每日两次），持续28天。建议二：CF基金会建议不要使用预防性抗假单胞菌抗生素来预防铜绿假单胞菌的获得（净效益的确定性，中度;净效益的估计，零;建议等级，D）。建议三：CF基金会建议对不能咳出痰液的CF患者进行常规口咽培养，而不是通过支气管镜检查获得的支气管肺泡灌洗培养，以确定他们是否感染了铜绿假单胞菌（净获益的确定性，中度;净获益的估计，中度;推荐等级，B）。
DESCRIPTION: The Cystic Fibrosis (CF) Foundation developed clinical care guidelines for the prevention of Pseudomonas aeruginosa infection, the treatment of initial P. aeruginosa infection, and the use of bronchoscopy to obtain routine airway cultures in individuals with CF.METHODS: A multidisciplinary committee developed questions about the prevention and treatment of initial P. aeruginosa infection and the use of bronchoscopy to obtain routine airway cultures. The outcome measure of interest was cultures without P. aeruginosa growth. Systematic reviews of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted in May 2012 and August 2013. Searches combined controlled vocabulary terms and text words for CF and terms relevant to each question. The entire committee reviewed the evidence, and final recommendation statements were graded using the U.S. Preventive Services Task Force system. Recommendation 1: The CF Foundation strongly recommends inhaled antibiotic therapy for the treatment of initial or new growth of P. aeruginosa from an airway culture (certainty of net benefit, high; estimate of net benefit, substantial; grade of recommendation, A). The favored antibiotic regimen is inhaled tobramycin (300 mg twice daily) for 28 days. Recommendation 2: The CF Foundation recommends against the use of prophylactic antipseudomonal antibiotics to prevent the acquisition P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, zero; grade of recommendation, D). Recommendation 3: The CF Foundation recommends routine oropharyngeal cultures rather than bronchoalveolar lavage cultures obtained by bronchoscopy in individuals with CF who cannot expectorate sputum to determine if they are infected with P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, moderate; grade of recommendation, B).