Antibiotic management of lung infections in cystic fibrosis. II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi.
Antibiotic management of lung infections in cystic fibrosis. II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi.
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DOI：
10.1513/annalsats.201405-203as
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发表时间：
2014-10-01
影响因子：
8.3
通讯作者：
Ratjen, Felix A
中科院分区：
文献类型：
--
作者：
Chmiel, James F;Aksamit, Timothy R;Ratjen, Felix A
呼吸道感染是囊性纤维化（CF）肺病的关键组成部分。虽然对铜绿假单胞菌等常见病原体的方法是由大量证据指导的，但其他感染往往对治疗医生构成相当大的挑战。在本系列的第一部分中，我们讨论了难治性肺部感染的抗生素管理，包括耐甲氧西林金黄色葡萄球菌，革兰氏阴性细菌感染和多种细菌病原体的治疗。在这里，我们总结了非结核分枝杆菌，厌氧菌和真菌感染的方法。非结核分枝杆菌可显著影响CF患者的肺部疾病病程，但临床上难以区分定植和感染，因为与其他微生物合并感染很常见。治疗包括不同类别的抗生素，强度不同，最好由专业临床医生和微生物学家团队指导。厌氧菌导致CF肺病的能力尚不清楚，尽管在个别患者中已报告了临床相关性。在CF痰中检测到的厌氧菌通常对多种药物具有耐药性，治疗尚未显示出对患者结局的积极影响。真菌作为潜在的CF病原体已经引起了极大的兴趣。虽然念珠菌的作用在很大程度上是不清楚的，有越来越多的证据表明，Scedosporium物种和烟曲霉菌，超越过敏性支气管肺曲霉菌病的经典表现，可以与CF患者和治疗应考虑。然而，目前，关于如何最好地选择可以从抗真菌治疗中获益的患者的信息仍然有限。
Airway infections are a key component of cystic fibrosis (CF) lung disease. Whereas the approach to common pathogens such as Pseudomonas aeruginosa is guided by a significant body of evidence, other infections often pose a considerable challenge to treating physicians. In Part I of this series on the antibiotic management of difficult lung infections, we discussed bacterial organisms including methicillin-resistant Staphylococcus aureus, gram-negative bacterial infections, and treatment of multiple bacterial pathogens. Here, we summarize the approach to infections with nontuberculous mycobacteria, anaerobic bacteria, and fungi. Nontuberculous mycobacteria can significantly impact the course of lung disease in patients with CF, but differentiation between colonization and infection is difficult clinically as coinfection with other micro-organisms is common. Treatment consists of different classes of antibiotics, varies in intensity, and is best guided by a team of specialized clinicians and microbiologists. The ability of anaerobic bacteria to contribute to CF lung disease is less clear, even though clinical relevance has been reported in individual patients. Anaerobes detected in CF sputum are often resistant to multiple drugs, and treatment has not yet been shown to positively affect patient outcome. Fungi have gained significant interest as potential CF pathogens. Although the role of Candida is largely unclear, there is mounting evidence that Scedosporium species and Aspergillus fumigatus, beyond the classical presentation of allergic bronchopulmonary aspergillosis, can be relevant in patients with CF and treatment should be considered. At present, however there remains limited information on how best to select patients who could benefit from antifungal therapy.