Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy?
Can early Burkholderia cepacia complex infection in cystic fibrosis be eradicated with antibiotic therapy?
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DOI：
10.3389/fcimb.2011.00018
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发表时间：
2011
影响因子：
5.7
通讯作者：
Jones A
中科院分区：
文献类型：
--
作者：
Horsley A;Webb K;Bright-Thomas R;Govan J;Jones A
洋葱伯克霍尔德菌复合体（BCC）的生物体是囊性纤维化（CF）的重要病原体。大多数获得基底细胞癌的人发展为慢性感染，但也可能导致显著少数人迅速下降。此外，在许多单位中，尤其是慢性结核杆菌感染被认为是肺移植的禁忌症。虽然在CF中采用积极的抗生素治疗以在感染不可逆转地建立之前根除铜绿假单胞菌，但尽管这种做法明显被广泛采用，但此前尚未报道对此类策略进行正式评估。方法：对英国成人CF中心进行调查，了解他们目前处理新发BCC感染的方法。在2002年1月1日至2011年5月1日期间，对曼彻斯特成人CF中心新分离BCC患者的根除治疗结果进行了评估。排除既往感染同一株BCC的患者。BCC在国家参考实验室鉴定，并通过物种特异性PCR和RecA测序证实。结果：在英国，常规使用治疗方法试图根除新的BCC是常用的（12/17有反应的中心）。这通常涉及静脉注射和雾化抗生素的组合。在19例符合条件的新发基底细胞癌感染病例中，有7例（37%）已被根除。其中3例未接受特异性根除治疗。在接受根除治疗并完成随访的14例患者中，只有4例（29%）BCC被清除。结论：在英国成人CF中心，尝试根除新发BCC是常见的做法。少数患者会自发清除感染，根除治疗的效果充其量是适度的。尽管没有足够的数据支持使用任何特定的治疗方案，但早期治疗可能与更好的结果相关。需要对治疗和结果进行前瞻性、系统的评估。
Introduction: Organisms of the Burkholderia cepacia complex (BCC) are important pathogens in cystic fibrosis (CF). The majority of those who acquire BCC develop chronic infection but it can also result in rapid decline in a significant minority. In addition, chronic infection with Burkholderia cenocepacia in particular is regarded as a contraindication to lung transplantation in many units. Whilst aggressive antibiotic therapy is employed in CF to eradicate Pseudomonas aeruginosa before infection becomes irreversibly established, no formal assessment of such strategies has been previously reported for BCC, despite the apparent widespread adoption of this practice. Methods: UK adult CF centers were surveyed about their current approach to new BCC infection. Outcomes of eradication therapy were assessed in patients attending the Manchester Adult CF Center with new BCC isolates between 1st January 2002 and 1st May 2011. Patients with previous infection with the same strain of BCC were excluded. BCC were identified at the national reference laboratories and confirmed by species-specific PCR and RecA sequencing. Results: Routine use of therapies to attempt eradication of new BCC is commonly used in the UK (12/17 centers who responded). This typically involves a combination of intravenous and nebulised antibiotics. Of 19 eligible cases of new BCC infection, the organism has been eradicated in 7 (37%). Three of these did not receive specific eradication therapy. Of 14 patients who have received eradication therapy and completed follow up, BCC were cleared in only 4 (29%). Conclusions: Attempted eradication of new BCC is a common practice in UK adult CF centers. A minority of patients clear the infection spontaneously and the effects of eradication therapies are at best modest. Early treatment may be associated with better outcomes, though there are insufficient data to support the use of any specific treatment regimen. A prospective, systematic evaluation of treatments and outcomes is required.
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影响因子：
4.1
作者：
Kaza, Seshu K.;McClean, Siobhan;Callaghan, Maire
通讯作者：
Callaghan, Maire
DOI：
10.1016/j.jcf.2004.01.005
发表时间：
2004-06-01
期刊：
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society
影响因子：
--
作者：
Courtney, J M;Dunbar, K E A;Elborn, J S
通讯作者：
Elborn, J S
DOI：
10.1164/ajrccm.161.4.9907147
发表时间：
2000-04-01
影响因子：
24.7
作者：
Aaron, SD;Ferris, W;MacDonald, NE
通讯作者：
MacDonald, NE
影响因子：
10
作者：
Jones, AM;Dodd, ME;Webb, AK
通讯作者：
Webb, AK
DOI：
10.1164/rccm.200503-344oc
发表时间：
2006-02-15
影响因子：
24.7
作者：
Kalish, LA;Waltz, DA;Goldmann, D
通讯作者：
Goldmann, D