As paradoxical as it may seem, the more we learn about some disease processes, the more we appreciate the challenges in refining their management. Airway infection in persons with cystic fibrosis (CF) is a case in point. For decades, our approach has been to apply Koch’s postulate to CF airway infections: bacteria in the airways are pathogens and antimicrobial therapy targeting these species improves health. The steadily improving health of the CF population as availability and use of antimicrobial therapies have increased has understandably reinforced this paradigm. However, as our appreciation of the complexity of CF airway microbiology has also increased it has become clear that we have been treating a poorly understood and complex infection with a set of therapies that are also rather poorly understood, at least with respect to their cumulative impact(s) on that system. Given what we know—and still don’t know—about this system, can we refine/improve outcomes? Is it reasonable to consider that reducing treatment complexity in this scenario may provide as much, or possibly more, benefit as adding further treatments? But testing this hypothesis is challenging. First, although changes in therapy must, by definition, involve a deviation from the current care standards, there is generally greater comfort with adding a new therapy rather than subtracting an …

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我们应该从 TEACH 中学到什么？


尽管看起来似乎很矛盾，但我们对某些疾病过程了解得越多，我们就越认识到完善其管理过程中所面临的挑战。囊性纤维化（CF）患者的气道感染就是一个很好的例子。几十年来，我们的方法一直是将科赫假设应用于 CF 气道感染：气道中的细菌是病原体，针对这些物种的抗菌治疗可以改善健康。随着抗菌疗法的可用性和使用的增加，CF 人群的健康状况稳步改善，这无疑强化了这一模式。然而，随着我们对 CF 气道微生物学复杂性的认识也随之增加，很明显，我们一直在用一套人们对 CF 气道微生物学了解甚少的复杂感染进行治疗，而这些疗法至少在其累积影响方面也知之甚少。 (s) 在该系统上。鉴于我们对这个系统的了解（以及仍然不了解），我们可以改进/改善结果吗？是否合理地认为，在这种情况下降低治疗复杂性可能会提供与增加进一步治疗一样多或可能更多的益处？但检验这一假设具有挑战性。首先，虽然根据定义，治疗的改变必须涉及偏离当前的护理标准，但添加新的治疗而不是减少……通常会更舒服。