Susceptibility testing of Pseudomonas aeruginosa isolates and clinical response to parenteral antibiotic administration -: Lack of association in cystic fibrosis
Susceptibility testing of Pseudomonas aeruginosa isolates and clinical response to parenteral antibiotic administration -: Lack of association in cystic fibrosis
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DOI：
10.1378/chest.123.5.1495
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发表时间：
2003-05-01
期刊：
影响因子：
9.6
通讯作者：
Burns, JL
中科院分区：
文献类型：
--
作者：
Smith, AL;Fiel, SB;Burns, JL
研究目的：为了确定囊性纤维化患者痰中分离的铜绿假单胞菌对抗生素的敏感性与患者对静脉注射抗生素的反应之间的关系，我们对妥布霉素雾化吸入3期试验中安慰剂组患者的数据进行了回顾性分析。所有患者均为慢性铜绿假单胞菌感染。在接受安慰剂治疗的262名患者中，有77名患者在试验期间经历了肺部恶化，他们接受了静脉注射妥布霉素和头孢他啶治疗。用微量肉汤稀释法测定铜绿假单胞菌对头孢他啶和妥布霉素的敏感性。设计：通过分析应用抗生素前后肺活量的差异，评估联合应用抗生素的临床疗效。在抗生素治疗结束后第一次就诊时预测的FEV1%与抗生素治疗前预测的FEV1%进行比较。结果：54例患者病情好转，9例病情恶化，14例应用抗生素后FEV1无变化。铜绿假单胞菌对妥布霉素或头孢他啶的敏感性与临床疗效无相关性。只观察到了以下三个变量。在回归分析中，与抗生素治疗后FEV1显著相关的因素有：治疗前的FEV1(p<；0.0001)；上次FEV1测量到开始静脉注射抗生素治疗之间的天数(p<；0.002)；以及确定最小抑制浓度和开始静脉注射治疗之间的天数(p<；0.03)。铜绿假单胞菌的抗生素敏感性和治疗结果之间没有明显的趋势。结论：虽然细菌敏感性和对非肠道抗生素的反应之间的趋势缺乏统计学意义并不意味着没有这种趋势，但可信区间的精确度使我们得出结论，即使分离的抗生素敏感性影响结果，影响也很小，并且与临床无关。
Study objective: To determine the relationship between the antibiotic susceptibility of Pseudomonas aeruginosa isolated from the sputum of patients with cystic fibrosis (CF) and the patient's response to parenteral antibiotic administration, we performed a retrospective analysis using data from patients in the placebo arm of a phase 3 trial of tobramycin solution for inhalation. All patients were chronically infected with P aeruginosa. Seventy-seven of the 262 patients receiving placebo experienced a pulmonary exacerbation during the trial for which they received therapy with IV tobramycin and ceftazidime. The susceptibility of the P aeruginosa isolates to ceftazidime and tobramycin was determined at trial enrollment by broth microdilution.Design: The clinical response to combination antibiotic therapy was assessed by analyzing differences in spirometry before and after antibiotic administration. The FEV1 percent predicted at the first visit after the conclusion of antibiotic administration was compared to the FEV1 percent predicted prior to antibiotic therapy. The results were analyzed both descriptively and by regression analyses.Results: The conditions of 54 patients improved, and those of 9 patients worsened, and in 14 patients there was no change in FEV1 with antibiotic administration. No correlation was observed between the susceptibility of P aeruginosa to tobramycin or ceftazidime and clinical response. Only the three following variables were observed. to significantly correlate with FEV1 after antibiotic treatment on regression analysis: FEV1 prior to treatment (p < 0.0001); number of days elapsed between the previous FEV1 measurement and the initiation of IV antibiotic therapy (p < 0.002); and the number of days elapsed between the determination of the minimum inhibitory concentration and the initiation of IV therapy (p < 0.03). No significant trends were observed between the antibiotic susceptibility of P aeruginosa isolates and treatment outcomes.Conclusion: While lack of statistical significance for a trend between bacterial susceptibilities and the response to parenteral antibiotic administration does not mean that no such trend exists, the precision of the confidence intervals allows us to conclude that even if isolate antibiotic susceptibilities affect outcome, the impact would be small and not clinically relevant.