A carregar...
Publicação
Antibioterapia inalada em doentes com fibrose quística infetados com pseudomonas aeruginosa
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 916 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Contexto: A fibrose quística (FQ), associada a mutações no gene CFTR, condiciona graves alterações no aparelho respiratório responsáveis pela colonização microbiológica persistente das vias aéreas destes doentes. Entre as quais, a Pseudomonas aeruginosa (PSAE) tem um papel de destaque pela sua difícil erradicação e mau prognóstico. Existem 4 antibióticos inalados anti-PSAE e neste trabalho foi comparada a eficácia de 2 esquemas terapêuticos (monoantibioterapia e antibioterapia dupla) na erradicação e na terapêutica supressora crónica dos doentes considerados elegíveis para o estudo. Métodos: Os dados foram colhidos a partir das notas de seguimento dos processos clínicos dos doentes elegíveis. Seguidamente foram registados e analisados estatisticamente. Resultados: 21 doentes foram considerados elegíveis, 7 doentes do sexo feminino e 14 do sexo masculino com média de 35,14 e 30,29 anos respetivamente. A estes doentes foi instituída a terapêutica de erradicação e verificou-se que 4 doentes erradicaram a infeção, 1 em regime de monoantibioterapia e 3 em regime de antibioterapia dupla. Aos 17 doentes que não erradicaram PSAE foi instituída terapia supressora crónica e estes foram seguidos durante 12 a 18 meses. Demonstrou-se melhores outcomes naqueles sob monoantibioterapia do que quando sob antibioterapia dupla no que respeita à ΔFEV1 (+1,61 vs. -4,6), ΔIMC (+0,85 vs. +0,41), exacerbações com necessidade de internamento (0 vs. 1) e infeções fúngicas concomitantes (3 doentes vs. 5 doentes), respetivamente. Conclusões: Apesar da antibioterapia dupla conferir um esquema mais agressivo no combate contra PSAE, os resultados obtidos podem ter sido devidos a outros fatores, potenciais causadores de viés, tais como um valor inicial mais baixo de FEV1, um maior número de doentes com insuficiência pancreática exócrina e maior colonização por outros agentes no grupo sob antibioterapia dupla. Adicionalmente, o facto de a amostra ser relativamente pequena pode ter influenciado os resultados obtidos pelo que se sugere estudos com uma amostra maior.
Background: Cystic fibrosis, a disease caused by several mutations associated to the CFTR gene, lead to severe changes in the airways causing persistent microbiologic colonization. Among them, Pseudomonas aeruginosa (PSAE) has a leading role because of its hard eradication and poor prognosis. Nowadays, there are available 4 inhaled antibiotics anti-PSAE and, in this work, it was compared the therapeutic effectiveness of 2 different schemes (monoantibiotic and double antibiotic therapy) regarding to eradication and suppression of chronic infection among the eligible patients. Methods: The data was collected based on patients’ follow-up notes. All the data was registered and statistically analysed. Results: 21 patients were considered eligible in which 7 were women and 14 were men. The median age was 35,14 and 30,29 years respectively. The eradication therapy was executed and the eradication itself was observed in 4 patients, 1 performing monoantibiotic and 3 performing double antibiotic therapy. The 17 patients, in which the eradication wasn’t noticed, were followed during 12 up to 18 months while doing suppression therapy. Better outcomes were found in the group performing monoantibiotic than double antibiotic therapy concerning the ΔFEV1 (+1,61 vs. -4,6), ΔBMI (+0,85 vs. +0,41), exacerbations leading to hospitalization (0 vs. 1) and fungal infections (3 patients vs. 5 patients), respectively. Conclusions: Despite the fact that double antibiotic therapy has a more aggressive strategy in this infection, several parameters may have influenced the outcome, such as a vast number of patients with a very low FEV1 at the time of diagnosis, a massive exocrine pancreatic insufficiency and also co-infection by other agents in this group. Nevertheless, a small sample like the one used in this work may have influenced. Therefore, studies with large samples are suggested.
Background: Cystic fibrosis, a disease caused by several mutations associated to the CFTR gene, lead to severe changes in the airways causing persistent microbiologic colonization. Among them, Pseudomonas aeruginosa (PSAE) has a leading role because of its hard eradication and poor prognosis. Nowadays, there are available 4 inhaled antibiotics anti-PSAE and, in this work, it was compared the therapeutic effectiveness of 2 different schemes (monoantibiotic and double antibiotic therapy) regarding to eradication and suppression of chronic infection among the eligible patients. Methods: The data was collected based on patients’ follow-up notes. All the data was registered and statistically analysed. Results: 21 patients were considered eligible in which 7 were women and 14 were men. The median age was 35,14 and 30,29 years respectively. The eradication therapy was executed and the eradication itself was observed in 4 patients, 1 performing monoantibiotic and 3 performing double antibiotic therapy. The 17 patients, in which the eradication wasn’t noticed, were followed during 12 up to 18 months while doing suppression therapy. Better outcomes were found in the group performing monoantibiotic than double antibiotic therapy concerning the ΔFEV1 (+1,61 vs. -4,6), ΔBMI (+0,85 vs. +0,41), exacerbations leading to hospitalization (0 vs. 1) and fungal infections (3 patients vs. 5 patients), respectively. Conclusions: Despite the fact that double antibiotic therapy has a more aggressive strategy in this infection, several parameters may have influenced the outcome, such as a vast number of patients with a very low FEV1 at the time of diagnosis, a massive exocrine pancreatic insufficiency and also co-infection by other agents in this group. Nevertheless, a small sample like the one used in this work may have influenced. Therefore, studies with large samples are suggested.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Fibrose quística Pseudomonas aeruginosa Antibioterapia Pneumologia