Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, England.
Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, England; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, England.
Chest. 2022 Jul;162(1):66-75. doi: 10.1016/j.chest.2022.02.007. Epub 2022 Feb 12.
Cystic fibrosis (CF) is characterized by chronic airway infection and progressive respiratory decline. Historically, a narrow spectrum of bacterial pathogens was believed to comprise the bulk of respiratory infections in CF, with Haemophilus influenzae and Staphylococcus aureus dominating childhood infections, and Pseudomonas aeruginosa or, less commonly, a member of the Burkholderia cepacia complex becoming the dominant infecting organism in adulthood. Today, the landscape is changing for airway infection in CF. The prevalence of "less typical" gram-negative bacterial infections are rising due to a number of factors: the CF population is aging; new therapies are being introduced; antibiotic usage is increasing; diagnostic tests are evolving; and taxonomic changes are being made as new bacterial species are being discovered. Less is known about the clinical relevance and evidence for treatment strategies for many of the other lower prevalence organisms that are encountered in CF. The aim of this article was to discuss the current evidence and recommended strategies for treating airway infection in CF, focusing on bacterial infections.
囊性纤维化(CF)的特征是慢性气道感染和进行性呼吸下降。历史上,人们认为窄谱细菌病原体构成了 CF 中大部分呼吸道感染的主要病原体,流感嗜血杆菌和金黄色葡萄球菌主导儿童感染,铜绿假单胞菌或不太常见的伯克霍尔德菌复合体能成为成年人感染的主要病原体。如今,CF 患者的气道感染情况正在发生变化。由于多种因素,“非典型”革兰氏阴性菌感染的流行率正在上升:CF 人群老龄化;新疗法正在引入;抗生素使用增加;诊断测试不断发展;随着新细菌物种的发现,分类学也在发生变化。对于 CF 中遇到的许多其他低流行率的生物体,人们对其临床相关性和治疗策略的了解较少。本文的目的是讨论目前治疗 CF 气道感染的证据和推荐策略,重点是细菌感染。