Probability of IV antibiotic retreatment within thirty days is associated with duration and location of IV antibiotic treatment for pulmonary exacerbation in cystic fibrosis

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• 作者：D.R. VanDevanter^a ; ^{Drv15@case.edu} ; P.A. Flume^b ; N. Morris^a ; M.W. Konstan^a ; ^c
• 关键词：Pulmonary exacerbation ; Treatment failure ; Risk factors
• 刊名：Journal of Cystic Fibrosis
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：15
• 期：6
• 页码：783-790
• 全文大小：506 K
• 卷排序：15

文摘

There are few objective data to guide management of cystic fibrosis (CF) pulmonary exacerbations. We studied intravenous (IV) antibiotic treatment failure as defined by a need to retreat patients with IV antibiotics within 30 days of completion of a prior IV antibiotic treatment for pulmonary exacerbation.MethodsThe first IV-treated exacerbation on or after Jan. 1, 2010 among US CF Foundation Patient Registry patients was studied, combining treatments separated by < 7 days into single treatments. IV treatment duration categories were: 1–4, 5–8, 9–12, 13–16, 17–22, and ≥ 23 days (inclusive). Logistic regressions for IV retreatment in ≤ 30 days were adjusted with 12 categorical covariates, including age, sex, lung function, prior-year exacerbations, CF complications, CF Care Program, and ever/never treated in hospital.Results777 of 13,579 patients (5.7%) were retreated within 30 days, with incidence varying by treatment duration: 1–4 days, 8.7%; 5–8 days; 6.6%; 9–12 days, 3.2%; 13–16 days, 4.5%; 17–22 days, 6.2%; ≥ 23 days, 10.3% and hospitalization: ever, 5.0%; never 8.5%. Adjusted odds ratios (OR) for retreatment (compared to 13–16 days treatment) were: 1–4 days, 1.94 [95%CI 1.49, 2.54] P < .001; 5–8 days, 1.55 [1.18, 2.04] P = .002; 9–12 days, 0.78 [0.58, 1.04] P = .09; 17–22 days, 1.12 [0.88, 1.42] P = .37; ≥ 23 days, 1.46 [1.12, 1.91] P = .005. Adjusted retreatment OR for never/ever hospitalized was 1.57 [1.29, 1.90] P < .001. Prior-year exacerbation number, oxygen therapy, non-invasive ventilation, and female sex were significantly associated with retreatment. Modeling hazard rate time-dependence showed that treatment duration and location-associated hazard rates attenuated within a few months after treatment.ConclusionAfter adjustment for covariates known to be associated with increased risk of IV treatment for exacerbation, IV antibiotic treatments of < 9 and ≥ 23 days and those without hospitalization were significant risk factors for IV retreatment within 30 days of completion of an exacerbation treatment.