Mariana Conceição, Michal Shteinberg, Pieter Goeminne, Josje Altenburg, James D Chalmers
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引用次数: 0
Abstract
Introduction: Pseudomonas aeruginosa is the most commonly isolated pathogen in bronchiectasis and is associated with worse outcomes. Eradication treatment is recommended by guidelines, but the evidence base is limited. The expected success rate of eradication in clinical practice is not known.
Methods: We conducted a systematic review and meta-analysis according to Meta-Analysis of Observational Studies in Epidemiology guidelines. PubMed, Embase, the Cochrane Database of Systematic Reviews and Clinicaltrials.gov were searched for studies investigating P. aeruginosa eradication treatment using antibiotics (systemic or inhaled) in patients with bronchiectasis. The primary outcome was the percentage of patients negative for P. aeruginosa at 12 months after eradication treatment. Cystic fibrosis was excluded.
Results: Six observational studies including 289 patients were included in the meta-analysis. Our meta-analysis found a 12-month P. aeruginosa eradication rate of 40% (95% CI 34-45%; p<0.00001), with no significant heterogeneity (I2=0%). Combined systemic and inhaled antibiotic treatment was associated with a higher eradication rate (48%, 95% CI 41-55%) than systemic antibiotics alone (27%, 13-45%).
Conclusion: Eradication treatment in bronchiectasis results in eradication of P. aeruginosa from sputum in ∼40% of cases at 12 months. Combined systemic and inhaled antibiotics achieve higher eradication rates than systemic antibiotics alone.
导言:铜绿假单胞菌是支气管扩张症中最常分离到的病原体,与恶化的预后有关。指南推荐进行根除治疗,但证据基础有限。临床实践中预期的根除成功率尚不清楚:根据流行病学观察性研究 Meta 分析指南,我们进行了系统回顾和荟萃分析。我们在PubMed、Embase、Cochrane系统综述数据库和Clinicaltrials.gov上搜索了有关支气管扩张患者使用抗生素(全身或吸入)根除铜绿假单胞菌的研究。主要结果为根除治疗后12个月铜绿假单胞菌阴性的患者比例。囊性纤维化除外:荟萃分析纳入了六项观察性研究,包括 289 名患者。我们的荟萃分析发现,12 个月的铜绿假单胞菌根除率为 40%(95% CI 34-45%;P2=0%)。与单独使用全身性抗生素(27%,13-45%)相比,联合使用全身性抗生素和吸入性抗生素治疗的根除率更高(48%,95% CI 41-55%):结论:支气管扩张症的根除治疗可使 40% 的病例在 12 个月内根除痰中的铜绿假单胞菌。与单独使用全身性抗生素相比,联合使用全身性抗生素和吸入性抗生素的根除率更高。
期刊介绍:
The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.