Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880-2018

Bacillus anthracis can cause anthrax and is a potential bioterrorism agent. The 2014 Centers for Disease Control and Prevention recommendations for medical countermeasures against anthrax were based on in vitro data and expert opinion. However, a century of previously uncompiled observational human...

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Veröffentlicht in:Clinical infectious diseases 2022-10, Vol.75 (Suppl 3), p.S392-S401
Hauptverfasser: Person, Marissa K, Cook, Rachel, Bradley, John S, Hupert, Nathaniel, Bower, William A, Hendricks, Katherine
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container_end_page S401
container_issue Suppl 3
container_start_page S392
container_title Clinical infectious diseases
container_volume 75
creator Person, Marissa K
Cook, Rachel
Bradley, John S
Hupert, Nathaniel
Bower, William A
Hendricks, Katherine
description Bacillus anthracis can cause anthrax and is a potential bioterrorism agent. The 2014 Centers for Disease Control and Prevention recommendations for medical countermeasures against anthrax were based on in vitro data and expert opinion. However, a century of previously uncompiled observational human data that often includes treatment and outcomes is available in the literature for analysis. We reviewed treatment outcomes for patients hospitalized with anthrax. We stratified patients by meningitis status, route of infection, and systemic criteria, then analyzed survival by treatment type, including antimicrobials, antitoxin/antiserum, and steroids. Using logistic regression, we calculated odds ratios and 95% confidence intervals to compare survival between treatments. We also calculated hospital length of stay. Finally, we evaluated antimicrobial postexposure prophylaxis (PEPAbx) using data from a 1970 Russian-language article. We identified 965 anthrax patients reported from 1880 through 2018. After exclusions, 605 remained: 430 adults, 145 children, and 30 missing age. Survival was low for untreated patients and meningitis patients, regardless of treatment. Most patients with localized cutaneous or nonmeningitis systemic anthrax survived with 1 or more antimicrobials; patients with inhalation anthrax without meningitis fared better with at least 2. Bactericidal antimicrobials were effective for systemic anthrax; addition of a protein synthesis inhibitor(s) (PSI) to a bactericidal antimicrobial(s) did not improve survival. Likewise, addition of antitoxin/antiserum to antimicrobials did not improve survival. Mannitol improved survival for meningitis patients, but steroids did not. PEPAbx reduced risk of anthrax following exposure to B. anthracis. Combination therapy appeared to be superior to monotherapy for inhalation anthrax without meningitis. For anthrax meningitis, neither monotherapy nor combination therapy were particularly effective; however, numbers were small. For localized cutaneous anthrax, monotherapy was sufficient. For B. anthracis exposures, PEPAbx was effective.
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subjects Adult
Anthrax - drug therapy
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents - therapeutic use
Antitoxins - therapeutic use
Bacillus anthracis
Biological Warfare Agents
Bioterrorism
Child
Hospitals
Humans
Mannitol - therapeutic use
Protein Synthesis Inhibitors - therapeutic use
Respiratory Tract Infections
Supplement
Treatment Outcome
title Systematic Review of Hospital Treatment Outcomes for Naturally Acquired and Bioterrorism-Related Anthrax, 1880-2018
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