title: Probability of IV antibiotic retreatment within thirty days is associated with duration and location of IV antibiotic treatment for pulmonary exacerbation in cystic fibrosis.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: Drv15@case.edu.
authors.forename: D R
authors.initials: DR
authors.lastname: VanDevanter
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Flume
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: N
authors.initials: N
authors.lastname: Morris
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA; Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Konstan
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D054539:Medication Therapy Management; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D012129:Respiratory Function Tests / Q000379:methods / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D019233:Retreatment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Pulmonary exacerbation; Risk factors; Treatment failure