囊性纤维化儿童的非结核分枝杆菌肺部感染

IF 3.1 4区 医学 Q2 INFECTIOUS DISEASES
Sabiha R. Hussain, Amira M. Said, Jeffrey R. Starke
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引用次数: 0

摘要

综述目的 随着囊性纤维化(CF)儿童和青少年寿命的延长,他们更容易受到非结核分枝杆菌(NTM)的肺部感染。大多数非结核分枝杆菌感染是由鸟分枝杆菌复合体(MAC)或脓肿分枝杆菌引起的。我们回顾了目前已知的治疗这些感染的方法和建议。最新研究结果MAC感染的治疗是标准化的循证治疗,包括三种口服药物的联合治疗,疗程为12个月。脓毒症鹅口疮感染的治疗更加困难,而且没有标准化,原因包括:缺乏杀菌药物;药物敏感性多变;体外抗生素敏感性测试无法预测临床成功率;缺乏随机试验数据指导治疗;需要进行初始肠外治疗;必要药物的不良反应率较高;部分药物成本高昂且供应有限。治疗包括最初的几个月,使用一种或多种肠外抗生素,然后使用几种最好的口服抗生素进行长期的持续治疗。小结脓毒症荚膜杆菌感染的治疗目标应在治疗开始前考虑,其目的通常是改善症状和生活质量,而不是根除病原体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nontuberculous Mycobacteria Pulmonary Infection in Children with Cystic Fibrosis

Purpose of Review

As children and adolescents with cystic fibrosis (CF) have lived longer, they have become more susceptible to pulmonary infection with nontuberculous mycobacteria (NTM). Most NTM infections are caused by the Mycobacterium avium complex (MAC) or Mycobacterium abscessus. We review what is currently known and recommended for treatment of these infections.

Recent Findings

Treatment of MAC infection is standardized and evidence-based, involving a combination of three oral drugs for 12 months. Treatment of M. abscessus infections is more difficult and not standardized owing to the: lack of bactericidal drugs; variability of drug susceptibilities; inability of in vitro antibiotic susceptibility testing to predict clinical success; lack of randomized trial data to guide therapy; need for initial parenteral therapy; higher rate of adverse reactions to the necessary medications; and high cost and limited availability of some of the drugs. Treatment involves an initial several month period including one or more parenteral antibiotics followed by a prolonged continuation phase using several of the best available oral antibiotics. Dual beta-lactam antibiotic and phage therapies offer some hope for improved outcomes in refractory cases.

Summary

The goals for therapy of M. abscessus infections should be considered prior to the onset of treatment, and often are aimed toward improvement in symptoms and quality of life rather that eradication of the organism.

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来源期刊
Current Infectious Disease Reports
Current Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
6.70
自引率
0.00%
发文量
19
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of infectious disease. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as HIV/AIDS, sexually transmitted diseases, tropical and travel medicine, and urinary tract infections. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists.
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