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Singh J, Hunt S, Simonds S, Boyton C, Middleton A, Elias M, Towns S, Pandit C, Robinson P, Fitzgerald DA, Selvadurai H. The changing epidemiology of pulmonary infection in children and adolescents with cystic fibrosis: an 18-year experience. Sci Rep 2024; 14:9056. [PMID: 38643191 PMCID: PMC11032396 DOI: 10.1038/s41598-024-59658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
The impact of evolving treatment regimens, airway clearance strategies, and antibiotic combinations on the incidence and prevalence of respiratory infection in cystic fibrosis (CF) in children and adolescents remains unclear. The incidence, prevalence, and prescription trends from 2002 to 2019 with 18,339 airway samples were analysed. Staphylococcus aureus [- 3.86% (95% CI - 5.28-2.43)] showed the largest annual decline in incidence, followed by Haemophilus influenzae [- 3.46% (95% CI - 4.95-1.96)] and Pseudomonas aeruginosa [- 2.80%95% CI (- 4.26-1.34)]. Non-tuberculous mycobacteria and Burkholderia cepacia showed a non-significant increase in incidence. A similar pattern of change in prevalence was observed. No change in trend was observed in infants < 2 years of age. The mean age of the first isolation of S. aureus (p < 0.001), P. aeruginosa (p < 0.001), H. influenza (p < 0.001), Serratia marcescens (p = 0.006) and Aspergillus fumigatus (p = 0.02) have increased. Nebulised amikacin (+ 3.09 ± 2.24 prescription/year, p = 0.003) and colistin (+ 1.95 ± 0.3 prescriptions/year, p = 0.032) were increasingly prescribed, while tobramycin (- 8.46 ± 4.7 prescriptions/year, p < 0.001) showed a decrease in prescription. Dornase alfa and hypertonic saline nebulisation prescription increased by 16.74 ± 4.1 prescriptions/year and 24 ± 4.6 prescriptions/year (p < 0.001). There is a shift in CF among respiratory pathogens and prescriptions which reflects the evolution of cystic fibrosis treatment strategies over time.
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Affiliation(s)
- Jagdev Singh
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
- Department of Pharmacy, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Sharon Hunt
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sharon Simonds
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie Boyton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Matthew Elias
- Department of Pharmacy, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Susan Towns
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Ramsey KA, Schultz A. Monitoring disease progression in childhood bronchiectasis. Front Pediatr 2022; 10:1010016. [PMID: 36186641 PMCID: PMC9523123 DOI: 10.3389/fped.2022.1010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Bronchiectasis (not related to cystic fibrosis) is a chronic lung disease caused by a range of etiologies but characterized by abnormal airway dilatation, recurrent respiratory symptoms, impaired quality of life and reduced life expectancy. Patients typically experience episodes of chronic wet cough and recurrent pulmonary exacerbations requiring hospitalization. Early diagnosis and management of childhood bronchiectasis are essential to prevent respiratory decline, optimize quality of life, minimize pulmonary exacerbations, and potentially reverse bronchial disease. Disease monitoring potentially allows for (1) the early detection of acute exacerbations, facilitating timely intervention, (2) tracking the rate of disease progression for prognostic purposes, and (3) quantifying the response to therapies. This narrative review article will discuss methods for monitoring disease progression in children with bronchiectasis, including lung imaging, respiratory function, patient-reported outcomes, respiratory exacerbations, sputum biomarkers, and nutritional outcomes.
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Affiliation(s)
- Kathryn A Ramsey
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia
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Webb K, Cámara M, Zain NMM, Halliday N, Bruce KD, Nash EF, Whitehouse JL, Knox A, Forrester D, Smyth AR, Williams P, Fogarty A, Barr HL. Novel detection of specific bacterial quorum sensing molecules in saliva: Potential non-invasive biomarkers for pulmonary Pseudomonas aeruginosa in cystic fibrosis. J Cyst Fibros 2021; 21:626-629. [PMID: 34518117 DOI: 10.1016/j.jcf.2021.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
Pseudomonas aeruginosa produces specific signalling molecules, 2-alkyl-4-quinolones (AQs) that are detectable in the sputum of adults with cystic fibrosis (CF) and who have pulmonary infection with this opportunistic pathogen. This study aimed to determine whether AQs could be detected in saliva of patients with CF and known infection with Pseudomonas aeruginosa. Saliva and sputum samples were obtained from 89 adults with CF and analyzed using liquid chromatography-tandem mass spectrometry. AQs were detected in 39/89 (43.8%) saliva samples and 70/77(90.9%) sputum samples. Salivary AQs had a sensitivity of 50% (95%CI; 37.8; 62.2), specificity of 100% (95%CI; 47.8; 100), when compared to a molecular microbiological measure of P. aeruginosa in sputum as measured using polymerase chain reaction. Specific AQs produced by P. aeruginosa can be detected in the saliva and warrant investigation as potential non-invasive biomarkers of pulmonary P. aeruginosa.
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Affiliation(s)
- Karmel Webb
- Division of Epidemiology and Public Health, Nottingham NIHR Biomedical Research Centre, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
| | - Miguel Cámara
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Nur Masirah M Zain
- Institute of Pharmaceutical Science, King's College London, London, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Nigel Halliday
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Kenneth D Bruce
- Institute of Pharmaceutical Science, King's College London, London, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Edward F Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Joanna L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Alan Knox
- Division of Respiratory Medicine, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Douglas Forrester
- Thoracic Programme, The Prince Charles Hospital, Brisbane, Australia; Nottingham MRC Molecular Pathology Node, UK
| | - Alan R Smyth
- School of Medicine, University of Nottingham, Nottingham, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Paul Williams
- National Biofilms Innovation Centre, Nottingham University Biodiscovery Institute, School of Life Sciences, University of Nottingham, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, Nottingham NIHR Biomedical Research Centre, University of Nottingham, City Hospital Campus, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Helen L Barr
- Wolfson Cystic Fibrosis Centre, Department of Respiratory Medicine, Nottingham NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Nottingham MRC Molecular Pathology Node, UK; UK NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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Marguet C, Houdouin V, Pin I, Reix P, Huet F, Mittaine M, Ramel S, Wizla-Derambure N, Abely M, Dalphin ML, Fayon M, Bihouée T, Le Bourgeois M, Deneuville E, Corvol H, Laurans M, Couderc L, Leroux E, Lémée L. Chest physiotherapy enhances detection of Pseudomonas aeruginosa in nonexpectorating children with cystic fibrosis. ERJ Open Res 2021; 7:00513-2020. [PMID: 33718497 PMCID: PMC7938055 DOI: 10.1183/23120541.00513-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/06/2020] [Indexed: 11/05/2022] Open
Abstract
Lung damage in cystic fibrosis (CF) is strongly associated with lower airway infections. Early treatment of Pseudomonas aeruginosa is recommended. Pathogen detection requires sampling of lower airway secretions, which remains a challenge in nonexpectorating patients. Our hypothesis was that chest physiotherapy would improve the quality of airway secretion samples and increase the rates of pathogens detected in nonexpectorating patients. This prospective multicentre study compared three successive methods for sampling airway secretions applied through the same session: 1) an oropharyngeal swab (OP), 2) a chest physiotherapy session followed by a provoked cough to obtain sputum (CP-SP) and 3) a second oropharyngeal swab collected after chest physiotherapy (CP-OP). Haemophilus influenzae, Staphylococcus aureus and P. aeruginosa growth cultures were assessed. Accuracy tests and an equivalence test were performed to compare the three successive methods of collection. 300 nonexpectorating children with CF were included. P. aeruginosa was detected cumulatively in 56 (18.9%) children, and according to the different collection methods in 28 (9.8%), 37 (12.4%) and 44 (14.7%) children by using OP, CP-OP and CP-SP, respectively. Compared with OP, the increased detection rate was +22% for CP-OP (p=0.029) and +57% for CP-SP (p=0.003). CP-SP had the best positive predictive value (86.3%) and negative predictive value (96.0%) for P. aeruginosa compared with the overall detection. The results of this adequately powered study show differences in the rates of pathogens detected according to the sampling method used. Chest physiotherapy enhanced detection of P. aeruginosa in nonexpectorating children with CF. Sputum collection after a chest physiotherapy session strongly enhances the detection of P. aeruginosa in nonexpectorating CF children compared with the commonly used oropharyngeal swab method. Oropharyngeal swab after physiotherapy may be an acceptable alternative.https://bit.ly/3757ewq
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Affiliation(s)
- Christophe Marguet
- CF Centre, Dept of Paediatrics and Adolescent Medicine, University Hospital Charles Nicolle, CIC INSERM 1404, EA 2656, Rouen University, Rouen, France
| | - Véronique Houdouin
- Paediatric CF Centre, University Hospital Robert Debre, INSERM UMR S 976, Paris Diderot University, Paris, France
| | - Isabelle Pin
- Paediatric CF Centre, Grenoble Alpes University Hospital, INSERM, Institute for Advanced Bioscences, Grenoble Alpes University, Grenoble, France
| | - Philippe Reix
- Paediatric CF Centre, Hospices Civils de Lyon, UMR 5558 (EMET), CNRS, LBBE, Lyon University, Villeurbanne, France
| | - Frédéric Huet
- Paediatric CF Centre, Dijon University Hospital, Bourgogne University, Dijon, France
| | - Marie Mittaine
- Paediatric CF Centre, Toulouse University Hospital, Toulouse III Paul Sabatier University, Toulouse, France
| | - Sophie Ramel
- CF Centre, Centre Perardihy, Service de Soins de Suite Nutritionnelle et Respiratoire, Roskoff, France
| | - Nathalie Wizla-Derambure
- Pediatric CF Centre, Dept of Paediatrics, Lille University Jeanne de Flandre Hospital, Lille University, Lille, France
| | - Michel Abely
- CF Centre, Dept of Paediatrcs, Reims University Hospital, Reims Champagne Ardennes University, Reims, France
| | - Marie-Laure Dalphin
- CF Centre, Dept of Paediatrics, Besançon University Hospital, Franche-Comté University, Besançon, France
| | - Michael Fayon
- Paediatric CF Centre, GH Pellegrin, Hôpital des Enfants, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - Tiphaine Bihouée
- Paediatric CF Centre, Nantes Children and Adolescent University Hospital, Nantes University, Nantes, France
| | - Muriel Le Bourgeois
- Paediatric CF Centre, Service de Pneumo-Allergologie Pédiatrique, Hôpital Universitaire Necker-Enfant Malades, AP-HP, Paris, France
| | - Eric Deneuville
- CF Centre, Dept of Paediatrics, Rennes University South Hospital, Rennes University, Rennes, France
| | - Harriet Corvol
- Paediatric CF Centre, Trousseau Hospital, Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA), AP-HP, Paris, France
| | - Muriel Laurans
- CF Centre, Dept of Paediatrics, Caen University Childrens Hospital, Caen University, Caen, France
| | - Laure Couderc
- CF Centre, Dept of Paediatrics and Adolescent Medicine, University Hospital Charles Nicolle, CIC INSERM 1404, EA 2656, Rouen University, Rouen, France
| | | | - Ludovic Lémée
- Bacteriology Unit, Dept of Microbiology, University Hospital Charles Nicolle, EA 2656, Rouen University, Rouen, France
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