Probability of IV antibiotic retreatment within thirty days is associated with duration and location of IV antibiotic treatment for pulmonary exacerbation in cystic fibrosis

J Cyst Fibros. 2016 Nov;15(6):783-790. doi: 10.1016/j.jcf.2016.04.005. Epub 2016 Apr 29.

Abstract

Background: There are few objective data to guide management of cystic fibrosis (CF) pulmonary exacerbations. We studied intravenous (IV) antibiotic treatment failure as defined by a need to retreat patients with IV antibiotics within 30days of completion of a prior IV antibiotic treatment for pulmonary exacerbation.

Methods: The first IV-treated exacerbation on or after Jan. 1, 2010 among US CF Foundation Patient Registry patients was studied, combining treatments separated by <7days into single treatments. IV treatment duration categories were: 1-4, 5-8, 9-12, 13-16, 17-22, and ≥23days (inclusive). Logistic regressions for IV retreatment in ≤30days were adjusted with 12 categorical covariates, including age, sex, lung function, prior-year exacerbations, CF complications, CF Care Program, and ever/never treated in hospital.

Results: 777 of 13,579 patients (5.7%) were retreated within 30days, with incidence varying by treatment duration: 1-4days, 8.7%; 5-8days; 6.6%; 9-12days, 3.2%; 13-16days, 4.5%; 17-22days, 6.2%; ≥23days, 10.3% and hospitalization: ever, 5.0%; never 8.5%. Adjusted odds ratios (OR) for retreatment (compared to 13-16days treatment) were: 1-4days, 1.94 [95%CI 1.49, 2.54] P<.001; 5-8days, 1.55 [1.18, 2.04] P=.002; 9-12days, 0.78 [0.58, 1.04] P=.09; 17-22days, 1.12 [0.88, 1.42] P=.37; ≥23days, 1.46 [1.12, 1.91] P=.005. Adjusted retreatment OR for never/ever hospitalized was 1.57 [1.29, 1.90] P<.001. Prior-year exacerbation number, oxygen therapy, non-invasive ventilation, and female sex were significantly associated with retreatment. Modeling hazard rate time-dependence showed that treatment duration and location-associated hazard rates attenuated within a few months after treatment.

Conclusion: After adjustment for covariates known to be associated with increased risk of IV treatment for exacerbation, IV antibiotic treatments of <9 and ≥23days and those without hospitalization were significant risk factors for IV retreatment within 30days of completion of an exacerbation treatment.

Keywords: Pulmonary exacerbation; Risk factors; Treatment failure.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Anti-Bacterial Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / epidemiology
  • Cystic Fibrosis* / therapy
  • Disease Progression
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Lung / physiopathology*
  • Male
  • Medication Therapy Management
  • Noninvasive Ventilation / statistics & numerical data
  • Oxygen Inhalation Therapy / statistics & numerical data
  • Respiratory Function Tests / methods
  • Respiratory Function Tests / statistics & numerical data
  • Respiratory Tract Infections* / drug therapy
  • Respiratory Tract Infections* / etiology
  • Respiratory Tract Infections* / physiopathology
  • Retreatment* / methods
  • Retreatment* / statistics & numerical data
  • Risk Factors
  • Sex Factors
  • Statistics as Topic
  • Time Factors
  • United States / epidemiology

Substances

  • Anti-Bacterial Agents