背景:图拉西斯,Tularemia的病原体,在整个北半球都是地方性的,只需要10种生物就可以引起疾病,使这种潜在的生物恐怖主义剂成为已知的最具传染性的细菌病原体之一。氨基糖苷类,四环素,and,最近,氟喹诺酮类药物被用于治疗兔热病;然而,关于这些和其他抗菌类别的相对有效性的数据是有限的。
方法:九个数据库,包括Medline,全球卫生,和Embase,系统地搜索了包含与tularemia相关术语的文章。有病例级数据的文章,抗菌治疗,并纳入患者预后。患者人口统计学,临床发现,抗菌药物管理,和结果(例如,插管,死亡率)使用标准化表格进行抽象。
结果:在确定和筛选的8878种出版物中,描述1993年至2023年870例病例的410篇文章符合纳入标准。报告的病例来自35个国家;一半以上来自美国,土耳其,或者西班牙。最常见的临床形式是输尿管,口咽,腺体,和肺炎。在接受氨基糖苷类治疗的患者中(n=452[52%]),氟喹诺酮类药物(n=339[39%]),或四环素(n=419[48%]),死亡率为0.7%,0.9%,和1.2%,分别。与接受氨基糖苷类和四环素类药物的患者相比,接受环丙沙星的肺炎疾病患者没有死亡,胸腔穿刺术/胸腔积液引流和插管的发生率最低。
结论:氨基糖苷类,氟喹诺酮类药物,四环素是治疗兔热病的有效抗菌药物,无论临床表现如何。特别是对于肺炎,与其他抗菌剂相比,环丙沙星可能有轻微的优势。
Francisella tularensis, the causative agent of tularemia, is endemic throughout the Northern Hemisphere and requires as few as 10 organisms to cause disease, making this potential bioterrorism agent one of the most infectious bacterial pathogens known. Aminoglycosides, tetracyclines, and, more recently, fluoroquinolones are used for treatment of tularemia; however, data on the relative effectiveness of these and other antimicrobial classes are limited.
Nine databases, including Medline, Global Health, and Embase, were systematically searched for articles containing terms related to tularemia. Articles with case-level data on tularemia diagnosis, antimicrobial treatment, and patient outcome were included. Patient demographics, clinical findings, antimicrobial administration, and outcome (eg, intubation, fatality) were abstracted using a standardized form.
Of the 8878 publications identified and screened, 410 articles describing 870 cases from 1993 to 2023 met inclusion criteria. Cases were reported from 35 countries; more than half were from the United States, Turkey, or Spain. The most common clinical forms were ulceroglandular, oropharyngeal, glandular, and pneumonic disease. Among patients treated with aminoglycosides (n = 452 [52%]), fluoroquinolones (n = 339 [39%]), or tetracyclines (n = 419 [48%]), the fatality rate was 0.7%, 0.9%, and 1.2%, respectively. Patients with pneumonic disease who received ciprofloxacin had no fatalities and the lowest rates of thoracentesis/pleural effusion drainage and intubation compared to those who received aminoglycosides and tetracyclines.
Aminoglycosides, fluoroquinolones, and tetracyclines are effective antimicrobials for treatment of tularemia, regardless of clinical manifestation. For pneumonic disease specifically, ciprofloxacin may have slight advantages compared to other antimicrobials.