Highlights
- •We searched the ECFS-PR for inhaled antibiotic use in pwCF without PA infection.
- •30% of pwCF not chronically PA infected were treated with inhaled antibiotics.
- •The major determinant of inhaled antibiotic use is past chronic infection with PA.
- •Over follow up, no benefit has been seen for treatment with inhaled antibiotics.
- •Randomized trials of inhaled antibiotics in pwCF without PA infection are needed.
Abstract
Background
Long-term treatment with inhaled antibiotics is recommended for people with cystic
fibrosis (pwCF) chronically infected with Pseudomonas aeruginosa (PA). However, pwCF without chronic PA infection are also commonly treated with inhaled
antibiotics. Using data from the European Cystic Fibrosis Patient Registry (ECFSPR)
we aimed to determine the prevalence and factors associated with inhaled antibiotic
treatment in pwCF without chronic PA infection, and long-term outcomes with inhaled
antibiotics use.
Methods
The ECFSPR was searched for pwCF 6 years of age and older who were not chronically
infected with PA at baseline. Factors associated with inhaled antibiotic use were
first assessed through a logistic regression. From this model a propensity score was
computed for each individual, providing the likelihood of being treated with inhaled
antibiotics. Long-term outcomes with and without inhaled antibiotics were assessed
separately for propensity scores tertiles.
Results
7210 pwCF without chronic PA infection at baseline were included, with 2722 (37.75%)
receiving long-term treatment with inhaled antibiotics. Treatment with inhaled antibiotics
was more prevalent with severe genotype, diabetes, pancreatic insufficiency, and past
infection with chronic PA (OR 3.8, 95% CI, 2.88–5.04). Treatment with inhaled antibiotics
was not associated with a reduced risk for acquisition of PA or other resistant pathogens,
or with improved lung function decline, mortality, or transplantation.
Conclusions
Many pwCF without chronic PA infection are receiving long-term treatment with inhaled
antibiotics despite lack of support from clinical trials or practice guidelines. We
did not observe improve outcomes with inhaled antibiotics. Our findings suggest controlled
studies evaluating specific inhaled antibiotic regimens targeting specific pathogens
or indications be performed to determine their effect.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: August 28, 2022
Accepted:
August 13,
2022
Received in revised form:
August 11,
2022
Received:
February 2,
2022
Identification
Copyright
© 2022 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
