Antibiotic Treatment of Signs and Symptoms of Pulmonary Exacerbations: A Comparison by Care Site
Antibiotic Treatment of Signs and Symptoms of Pulmonary Exacerbations: A Comparison by Care Site
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DOI：
10.1002/ppul.23147
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发表时间：
2015-05-01
影响因子：
3.1
通讯作者：
Konstan, Michael W.
中科院分区：
文献类型：
--
作者：
Schechter, Michael S.;Regelmann, Warren E.;Konstan, Michael W.
背景 囊性纤维化肺部恶化的抗生素治疗效果不一致。先前的研究表明，在肺功能较好的场所，静脉注射抗生素的使用频率更高，但尚不清楚在什么情况下使用抗生素。 方法 参加囊性纤维化流行病学研究的儿科护理场所按照其随访儿童的 FEV1 预测中位数进行排名。将最高四分位数的患者与其他四分位数的患者在 21 天内报告的肺部病情加重 (PEx) 和抗生素治疗的新体征和症状进行比较，并根据患者的社会人口统计学和临床特征进行调整。结果最高四分位数站点共有 2,454 名符合本分析条件的儿童；下四分位站点总数为 5,487 个。最高位点与较低位点发生 PEx 的几率因 PEx 的定义方式而异，但高四分位位点均更有可能用抗生素治疗 PEx。由出现一种或两种新体征和症状定义的 PEx 的任何抗生素治疗的调整后比值比为 1.24 (95% CI 1.10, 1.40)；对于由出现三到四种新体征和症状定义的 PEx 治疗，该值为 1.50（95% CI 1.06，2.11）；对于由 FEV1 下降 -15% 定义的 PEx 治疗，该值为 1.33 (1.10, 1.60)。使用静脉注射抗生素治疗这些 PEx 的调整后 OR 分别为 1.11 (0.94, 1.32)、1.90 (1.32, 2.72) 和 1.33 (1.10, 1.60)。 结论 当患者出现轻微或明显的 PEx 证据时，FEV1 最高四分位数的 ESCF 护理机构更有可能开出抗生素。虽然这可能不是患者 FEV1 中值较高的唯一原因，但它可能是一个重要因素。小儿肺科。 2015年； 50：431-440。 (c) 2014 年 Wiley 期刊公司。
BackgroundAntibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed.MethodPediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV1 % predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients.ResultHighest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95% CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95% CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV1 by -15% was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively.ConclusionESCF care sites in the highest quartile for FEV1 were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor. Pediatr Pulmonol. 2015; 50:431-440. (c) 2014 Wiley Periodicals, Inc.