Ann Am Thorac Soc. 2023 Jun 16. doi: 10.1513/AnnalsATS.202301-078OC. Online ahead of print.
ABSTRACT
Rationale/Objective: Antibiotic selection for in-hospital treated pulmonary exacerbations (PEx) in people with cystic fibrosis (PwCF) is typically guided by previous respiratory culture results or past PEx antibiotic treatment. In the absence of clinical improvement during PEx treatment, antibiotics are frequently changed in search of a regimen that better alleviates symptoms and restores lung function. The clinical benefits of changing antibiotics during PEx treatment are largely uncharacterized.
METHODS: This was a retrospective cohort study utilizing the CF Foundation Patient Registry-Pediatric Health Information System. PEx were included if they occurred in children with CF from 6 to 21 years old who had been treated with IV antibiotics between January 1st, 2006, through December 31st, 2018. PEx with lengths of stay <5 or >21 days or where treatment was delivered in an intensive care unit were excluded. An antibiotic change was defined as addition or subtraction of any IV antibiotic between hospital day 6 and the day prior to hospital discharge. Inverse probability of treatment weighting was used to adjust for disease severity and indication bias, which might influence a decision to change antibiotics.
RESULTS: In all, 4099 children with CF contributed 18,745 PEx for analysis, of which 8,169 PEx (43.6%) included a change in IV antibiotics on or after day 6. The mean change in in pre- to post-treatment percent predicted forced expiratory volume in one second (ppFEV1) was 11.3 (standard error 0.21) among events in which an IV antibiotic change occurred versus 12.2 (0.18) among PEx without an IV antibiotic change (p=0.001). Similarly, the odds of return to ≥90% of baseline ppFEV1 were less for PEx with antibiotic changes than those without changes (odds ratio (OR) 0.89; [95% Confidence Interval (CI): 0.80-0.98]). Odds of returning to ≥100% of baseline ppFEV1 did not differ between PEx with versus without antibiotic changes (OR 0.94; [0.86-1.03]). In addition, PEx treated with IV antibiotic changes were associated with higher odds of future PEx (OR 1.17 [1.12-1.22]).
CONCLUSIONS: In this retrospective study, changing IV antibiotics during PEx treatment in children with CF was common and not associated with improved clinical outcomes.
PMID:37327485 | DOI:10.1513/AnnalsATS.202301-078OC
