Abstract：
BACKGROUND: The benefit of antibiotic treatment of acute drops in FEV1 percent predicted (FEV1pp) has been clearly established, but data from the early 2000s showed inconsistent treatment. Further, there is no empirical evidence for what magnitude of drop is clinically significant.
METHODS: We used data from the CF Foundation Patient Registry (CFFPR) from 2016 to 2019 to determine the association between treatment (any IV antibiotics, only oral or newly prescribed inhaled antibiotics, or no antibiotic therapy) following a decline of ≥5% from baseline FEV1pp and return to 100% baseline FEV1pp days using multivariable logistic regression including an interaction between the magnitude of decline and treatment category.
RESULTS: Overall, 16,495 PWCF had a decline: 16.5% were treated with IV antibiotics, 25.0% non-IV antibiotics, and 58.5% received no antibiotics. Antibiotic treatment was more likely for those with lower lung function, history of a positive PA culture, older age and larger FEV1 decline (p < 0.001). Treatment with IV antibiotics or oral/inhaled antibiotics was associated with a higher odds of recovery to baseline compared to no treatment across all levels of decline, including declines of 5%-10%.
CONCLUSIONS: A large proportion of acute drops in FEV1pp continue to be untreated, especially in younger patients and those with higher baseline lung function. Acute drops as small as 5% predicted are less likely to be recovered if antibiotic treatment is not prescribed. These findings suggest the need for more aggressive antimicrobial treatment of acute drops in FEV1, including those of a magnitude previously believed to be associated with self-recovery.
METHODS: We used data from the CF Foundation Patient Registry (CFFPR) from 2016 to 2019 to determine the association between treatment (any IV antibiotics, only oral or newly prescribed inhaled antibiotics, or no antibiotic therapy) following a decline of ≥5% from baseline FEV1pp and return to 100% baseline FEV1pp days using multivariable logistic regression including an interaction between the magnitude of decline and treatment category.
RESULTS: Overall, 16,495 PWCF had a decline: 16.5% were treated with IV antibiotics, 25.0% non-IV antibiotics, and 58.5% received no antibiotics. Antibiotic treatment was more likely for those with lower lung function, history of a positive PA culture, older age and larger FEV1 decline (p < 0.001). Treatment with IV antibiotics or oral/inhaled antibiotics was associated with a higher odds of recovery to baseline compared to no treatment across all levels of decline, including declines of 5%-10%.
CONCLUSIONS: A large proportion of acute drops in FEV1pp continue to be untreated, especially in younger patients and those with higher baseline lung function. Acute drops as small as 5% predicted are less likely to be recovered if antibiotic treatment is not prescribed. These findings suggest the need for more aggressive antimicrobial treatment of acute drops in FEV1, including those of a magnitude previously believed to be associated with self-recovery.
摘要：
背景：抗生素治疗FEV1预测百分比（FEV1pp）的急性下降的益处已经明确确立，但是2000年代初的数据显示治疗不一致。Further,没有经验证据表明下降的幅度在临床上是有意义的。
方法：我们使用了2016年至2019年CF基金会患者登记处（CFFPR）的数据来确定治疗之间的关联（任何IV抗生素，仅口服或新处方的吸入抗生素，或不使用抗生素治疗）从基线FEV1pp下降≥5％，并使用多变量逻辑回归返回至100％基线FEV1pp天，包括下降幅度与治疗类别之间的相互作用。
结果：总体而言，16,495PWCF下降：16.5％接受IV抗生素治疗，25.0%非静脉抗生素，58.5%未接受抗生素治疗。对于肺功能较低的人，抗生素治疗更有可能，积极的PA文化的历史，年龄较大，FEV1下降（p<0.001）。在所有水平的下降中，与没有治疗相比，使用静脉抗生素或口服/吸入抗生素治疗与较高的恢复到基线的几率相关。包括5%-10%的跌幅。
结论：FEV1pp中大部分急性滴剂继续未治疗，尤其是年轻患者和基线肺功能较高的患者。如果不规定抗生素治疗，则预计小至5％的急性滴剂不太可能恢复。这些发现表明需要对FEV1的急性滴剂进行更积极的抗菌治疗，包括以前认为与自我恢复有关的那些。
方法：我们使用了2016年至2019年CF基金会患者登记处（CFFPR）的数据来确定治疗之间的关联（任何IV抗生素，仅口服或新处方的吸入抗生素，或不使用抗生素治疗）从基线FEV1pp下降≥5％，并使用多变量逻辑回归返回至100％基线FEV1pp天，包括下降幅度与治疗类别之间的相互作用。
结果：总体而言，16,495PWCF下降：16.5％接受IV抗生素治疗，25.0%非静脉抗生素，58.5%未接受抗生素治疗。对于肺功能较低的人，抗生素治疗更有可能，积极的PA文化的历史，年龄较大，FEV1下降（p<0.001）。在所有水平的下降中，与没有治疗相比，使用静脉抗生素或口服/吸入抗生素治疗与较高的恢复到基线的几率相关。包括5%-10%的跌幅。
结论：FEV1pp中大部分急性滴剂继续未治疗，尤其是年轻患者和基线肺功能较高的患者。如果不规定抗生素治疗，则预计小至5％的急性滴剂不太可能恢复。这些发现表明需要对FEV1的急性滴剂进行更积极的抗菌治疗，包括以前认为与自我恢复有关的那些。
