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Cochrane Database of Systematic Reviews

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Esta versión no es la más reciente

ver la versión actual 15 mayo 2020

Información

DOI:
https://doi.org/10.1002/14651858.CD006961.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 19 junio 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Fibrosis quística y enfermedades genéticas

Copyright:
  1. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Valerie Waters

    Correspondencia a: Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada

    [email protected]

  • Felix Ratjen

    Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada

Contributions of authors

The review was conceived by Dr Valerie Waters. Dr Waters drafted the protocol with comments from Professor Felix Ratjen.

Dr Waters acts as guarantor of the review.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Institute for Health Research, UK.

    This systematic review was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group.

Declarations of interest

None known.

Clarification statement added from Alan Smyth, Co‐ordinating Editor on 19 March 2020: This review was found by the Cochrane Funding Arbiters, post‐publication, to be noncompliant with theCochrane conflict of interest policy, which includes the relevant parts of theCochrane Commercial Sponsorship Policy. The review will be updated by April 2020; the authors of the future update will be free of conflicts.

Acknowledgements

The authors acknowledge the kind assistance of Dr Shawn Aaron who provided us with the data specific for participants in his study infected with only P aeruginosa.

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2020 May 15

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Review

Sherie Smith, Felix Ratjen, Tracey Remmington, Valerie Waters

https://doi.org/10.1002/14651858.CD006961.pub5

2017 Jun 19

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Review

Valerie Waters, Felix Ratjen

https://doi.org/10.1002/14651858.CD006961.pub4

2015 Nov 02

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Review

Valerie Waters, Felix Ratjen

https://doi.org/10.1002/14651858.CD006961.pub3

2008 Jul 16

Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Review

Valerie Waters, Felix Ratjen

https://doi.org/10.1002/14651858.CD006961.pub2

2008 Jan 23

Antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis

Protocol

Valerie Waters, Felix Ratjen

https://doi.org/10.1002/14651858.CD006961

Differences between protocol and review

In 2017 a summary of findings table was added in line with guidance from Cochrane.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Combination antimicrobial susceptibility testing compared with conventional treatment (separate testing) for pulmonary exacerbation due to Pseudomonas aeruginosa in people with cystic fibrosis

Patient or population: adults and children with pulmonary exacerbation due to Pseudomonas aeruginosa

Settings: inpatient

Intervention: combination antimicrobial susceptibility testing

Comparison: conventional treatment (separate susceptibility testing)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

conventional treatment

combination susceptibility testing

Lung function
(FEV₁ or FVC L/min or % predicted)

Follow up: 14 days treatment with follow up every 3 months for up to 4.5 years

Outcome not reported ‐ see comment.

N/A

N/A

N/A

Lung function outcomes were not reported separately for individuals with infection due to Pseudomonas aeruginosa.

Time to next exacerbation

Follow up: up to 4.5 years

The only data available for the time to next exacerbation due to Pseudomonas aeruginosa gave a hazard ratio of 0.82 for the conventional (control) group compared to the combination antimicrobial susceptibility testing group (95% CI 0.44 to 1.51) (P = 0.52).

N/A

1

(82)

⊕⊕⊕⊝
moderate1

Quality of life

Outcome not reported ‐ see comment.

N/A

N/A

N/A

This outcome wasn't reported in the included study.

Length of hospital stay

Follow up: up to 4.5 years

Outcome not reported ‐ see comment.

N/A

N/A

N/A

This outcome was not reported separately for people with infection due to Pseudomonas aeruginosa.

Sputum bacterial density measured in colony forming units/mL

Follow up: up to 4.5 years

Outcome not reported ‐ see comment.

N/A

N/A

N/A

This outcome was not reported separately for people with infection due to Pseudomonas aeruginosa.

Adverse events

Follow up: up to 4.5 years

Outcome not reported ‐ see comment.

N/A

N/A

N/A

This outcome was not reported separately for people with infection due to Pseudomonas aeruginosa.

There were 9 serious adverse events in all participants: 2/64 in the combination antimicrobial susceptibility testing group and 7/68 in the control group (P = 0.17).

Mortality

Follow up: up to 4.5 years

Outcome not reported ‐ see comment.

N/A

N/A

N/A

This outcome was not reported separately for people with infection due to Pseudomonas aeruginosa.

There were 2 deaths in all participants during the study period, both in the control group.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; N/A: not applicable.

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1. Downgrade once for imprecision as there is only one included study and therefore the number of participants is low.

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