Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes
Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes
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DOI：
10.1164/rccm.201001-0057oc
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发表时间：
2010-11-01
影响因子：
24.7
通讯作者：
Mogayzel, Peter J., Jr.
中科院分区：
文献类型：
--
作者：
Collaco, J. Michael;Green, Deanna M.;Mogayzel, Peter J., Jr.
囊性纤维化（CF）患者易患反复呼吸道感染（加重），通常需要静脉注射抗生素治疗，并可能导致肺功能永久丧失。目的：确定静脉注射抗生素的时间或地点是否会影响肺功能。方法：回顾性收集2000年至2007年美国CF护理中心的1,535名受试者的数据，这些受试者是由美国CF双胞胎和同胞研究招募的。无论是否在医院使用抗生素，急性加重后FEV（1）均观察到长期下降（平均值，-3.3个百分点[95%置信区间，-3.9至-2.6]; n = 602个疗程）或在家（平均值，-3.5个百分点[95%置信区间，-4.5至-2.5]; n = 232个疗程）;这种下降在使用巢（P = 0.69）或回归（P = 0.91）的地点之间没有差异。在医院（中位数，119 d [四分位数间距，166]; n = 602）和家庭（中位数，98 d [四分位数间距，155]; n = 232）之间未观察到抗生素疗程之间的间隔差异（P = 0.29）。急性加重时FEV（1）下降幅度较大的患者，即使肺功能最初经治疗恢复，其长期下降幅度也更大（P < 0.001）。在急性发作治疗期间获得的FEV（1）测量结果表明，FEV（1）的改善在7-10天的therapeutic.Conclusions：CF呼吸急性发作在医院和在家里进行的静脉抗生素治疗在长期FEV（1）变化和抗生素疗程之间的间隔方面是等效的。治疗的最佳持续时间（7-10天）可能比目前的做法短。需要大型前瞻性研究来回答CF呼吸管理的这些基本问题。
Rationale Individuals with cystic fibrosis (CF) are subject to recurrent respiratory infections (exacerbations) that often require intravenous antibiotic treatment and may result in permanent loss of lung function. The optimal means of delivering therapy remains unclear.Objectives: To determine whether duration or venue of intravenous antibiotic administration affect lung function.Methods: Data were retrospectively collected on 1,535 subjects recruited by the US CF Twin and Sibling Study from US CF care centers between 2000 and 2007.Measurements and Main Results: Long-term decline in FEV(1) after exacerbation was observed regardless of whether antibiotics were administered in the hospital (mean, -3.3 percentage points [95% confidence interval, -3.9 to -2.6]; n = 602 courses of therapy) or at home (mean, -3.5 percentage points [95% confidence interval, -4.5 to -2.5]; n = 232 courses of therapy); this decline was not different by venue using nests (P = 0.69) or regression (P = 0.91). No difference in intervals between courses of antibiotics was observed between hospital (median, 119 d [interquartile range, 166]; n = 602) and home (median, 98 d [interquartile range, 155]; n = 232) (P = 0.29). Patients with greater drops in FEV(1) with exacerbations had worse long-term decline even if lung function initially recovered with treatment (P < 0.001). Examination of FEV(1) measures obtained during treatment for exacerbations indicated that improvement in FEV(1) plateaus after 7-10 days of therapy.Conclusions: Intravenous antibiotic therapy for CF respiratory exacerbations administered in the hospital and in the home was found to be equivalent in terms of long-term FEV(1) change and interval between courses of antibiotics. Optimal duration of therapy (7-10 d) may be shorter than current practice. Large prospective studies are needed to answer these essential questions for CF respiratory management.