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Sheykhsaran E, Abbasi A, Memar MY, Ghotaslou R, Baghi HB, Mazraeh FN, Laghousi D, Sadeghi J. The role of Staphylococcus aureus in cystic fibrosis pathogenesis and clinico-microbiological interactions. Diagn Microbiol Infect Dis 2024; 109:116294. [PMID: 38678689 DOI: 10.1016/j.diagmicrobio.2024.116294] [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: 07/28/2023] [Revised: 01/05/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
Cystic fibrosis (CF) is a progressive and inherited disease that affects approximately 70000 individuals all over the world annually. A mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene serves as its defining feature. Bacterial infections have a significant impact on the occurrence and development of CF. In this manuscript, we discuss the role and virulence factors of Staphylococcus aureus as an important human pathogen with the ability to induce respiratory tract infections. Recent studies have reported S. aureus as the first isolated bacteria in CF patients. Methicillin-resistant Staphylococcus aureus (MRSA) pathogens are approximately resistant to all β-lactams. CF patients are colonized by MRSA expressing various virulence factors including toxins, and Staphylococcal Cassette Chromosome mec (SCCmec) types, and have the potential for biofilm formation. Therefore, variations in clinical outcomes will be manifested. SCCmec type II has been reported in CF patients more than in other SCCmec types from different countries. The small-colony variants (SCVs) as specific morphologic subtypes of S. aureus with slow growth and unusual properties can also contribute to persistent and difficult-to-treat infections in CF patients. The pathophysiology of SCVs is complicated and not fully understood. Patients with cystic fibrosis should be aware of the intrinsic risk factors for complex S. aureus infections, including recurring infections, physiological issues, or coinfection with P. aeruginosa.
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Affiliation(s)
- Elham Sheykhsaran
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Abbasi
- Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Naeimi Mazraeh
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Delara Laghousi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Sadeghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Biggs SL, Jennison AV, Bergh H, Graham R, Nimmo G, Whiley D. Limited evidence of patient-to-patient transmission of Staphylococcus aureus strains between children with cystic fibrosis, Queensland, Australia. PLoS One 2022; 17:e0275256. [PMID: 36206247 PMCID: PMC9543978 DOI: 10.1371/journal.pone.0275256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Here we used whole genome sequencing (WGS) to understand strain diversity and potential for patient-to-patient transmission of Staphylococcus aureus among children with cystic fibrosis (CF) in Queensland, Australia. METHODS S. aureus isolates (n = 401) collected between January 2018 and April 2019 from 184 patients with CF (n = 318 isolates) and 76 patients without CF (n = 83 isolates) were subjected to WGS and subsequent multilocus sequence typing (MLST), and a phylogeny was constructed from core genome single nucleotide polymorphism (SNP) analysis. The subsequent data was compared with available patient information. RESULTS WGS revealed that patients with CF were essentially colonised by the same genotypes as those seen in patients without CF. Sequence types (ST) for our patients with CF were predominantly ST5 (20.1%), ST30 (7.3%), ST15 (6.3%) and ST8 (5.3%). Two Australian clones, ST93 and ST239, typically seen in skin infections and health-care settings, respectively, were notably absent from our patients with CF. Based on a SNP distance threshold of 14 SNPs, 20 cluster types involving 50/260 patients were evident; of these, 6 clusters contained only patients found to be siblings or otherwise living in the same household. Epidemiological relationships could not be determined for a remaining 14 cluster types involving 38 patients, comprising 2-7 (median 2) patients each. Multiple S. aureus genotypes were observed in 19/73 CF patients who provided more than one sample. CONCLUSION These results show that WGS is a useful tool for surveillance of S. aureus strains in children with CF and that the strains in our CF cohort were largely consistent with those circulating in patients without CF. Overall, this confirms previous findings and indicates that S. aureus acquisition in children with CF is similar to that of other patient groups, with limited evidence of potential patient-to-patient transmission within this patient group.
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Affiliation(s)
- Sharon L. Biggs
- School of Medicine, The University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
| | - Amy V. Jennison
- Public and Environmental Health, Forensic and Scientific Services, Coopers Plains, Queensland, Australia
| | - Haakon Bergh
- Pathology Queensland Central Laboratory, Herston, Queensland, Australia
| | - Rikki Graham
- Public and Environmental Health, Forensic and Scientific Services, Coopers Plains, Queensland, Australia
| | - Graeme Nimmo
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - David Whiley
- School of Medicine, The University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia
- Pathology Queensland Central Laboratory, Herston, Queensland, Australia
- * E-mail:
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Stoudemire W, Jiang X, Zhou JJ, Kosorok MR, Saiman L, Muhlebach MS. Predicting risk-adjusted incidence rates of methicillin-resistant Staphylococcus Aureus and Pseudomonas Aeruginosa in cystic fibrosis programs in the United States. J Cyst Fibros 2022; 21:1013-1019. [PMID: 35963814 DOI: 10.1016/j.jcf.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Healthcare-associated transmission of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa occurs for people with cystic fibrosis (CF), but CF programs lack a process to monitor incidence rates (IRs). We assessed predictors of incident infections and created a model to determine risk-adjusted IRs for CF programs. METHODS Using the CF Foundation Patient Registry data for all patients from 2012 to 2015, coefficients for variables that predicted IRs were estimated. Hazard functions were then used to predict IRs of MRSA and P. aeruginosa for CF programs based on their patient and program characteristics. Predicted IRs were compared with observed IRs over multiple time intervals. RESULTS Multiple patient and program characteristics were identified as predictors of observed IRs. Our model's predicted IRs closely aligned with observed IRs for most CF programs. Alarm values (defined as observed IR > 95% confidence interval of predicted IR) were found at 5.9%, 5.9%, 6.0% (adult, pediatric, affiliate) of programs for MRSA and 3.0%, 1.7%, 0.0% (adult, pediatric, affiliate) of programs for P. aeruginosa. CONCLUSIONS We found patient and program characteristics that predicted MRSA and P. aeruginosa IRs. Our model accurately predicted risk-adjusted IRs of MRSA and P. aeruginosa. CF programs could use our model to monitor their IRs and potentially improve infection prevention and control.
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Affiliation(s)
- William Stoudemire
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, 450 MacNider Building, CB# 7217 321 S. Columbia Street, Chapel Hill, NC, United States.
| | - Xiaotong Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Juyan J Zhou
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States; Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY, United States
| | - Marianne S Muhlebach
- Department of Pediatrics, UNC School of Medicine, University of North Carolina, 450 MacNider Building, CB# 7217 321 S. Columbia Street, Chapel Hill, NC, United States
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Current and Emerging Therapies to Combat Cystic Fibrosis Lung Infections. Microorganisms 2021; 9:microorganisms9091874. [PMID: 34576767 PMCID: PMC8466233 DOI: 10.3390/microorganisms9091874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
The ultimate aim of any antimicrobial treatment is a better infection outcome for the patient. Here, we review the current state of treatment for bacterial infections in cystic fibrosis (CF) lung while also investigating potential new treatments being developed to see how they may change the dynamics of antimicrobial therapy. Treatment with antibiotics coupled with regular physical therapy has been shown to reduce exacerbations and may eradicate some strains. Therapies such as hypertonic saline and inhaled PulmozymeTM (DNase-I) improve mucus clearance, while modifier drugs, singly and more successfully in combination, re-open certain mutant forms of the cystic fibrosis transmembrane conductance regulator (CFTR) to enable ion passage. No current method, however, completely eradicates infection, mainly due to bacterial survival within biofilm aggregates. Lung transplants increase lifespan, but reinfection is a continuing problem. CFTR modifiers normalise ion transport for the affected mutations, but there is conflicting evidence on bacterial clearance. Emerging treatments combine antibiotics with novel compounds including quorum-sensing inhibitors, antioxidants, and enzymes, or with bacteriophages, aiming to disrupt the biofilm matrix and improve antibiotic access. Other treatments involve bacteriophages that target, infect and kill bacteria. These novel therapeutic approaches are showing good promise in vitro, and a few have made the leap to in vivo testing.
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Porterfield HS, Maakestad LJ, LaMarche MM, Thurman AL, Kienenberger ZE, Pitcher NJ, Hansen AR, Zirbes CF, Boyken L, Muyskens BL, Pezzulo AA, Singh SB, Twait E, Ford B, Diekema DJ, Reeb V, Fischer AJ. MRSA strains with distinct accessory genes predominate at different ages in cystic fibrosis. Pediatr Pulmonol 2021; 56:2868-2878. [PMID: 34219414 PMCID: PMC8395597 DOI: 10.1002/ppul.25559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/30/2023]
Abstract
RATIONALE Methicillin resistant Staphylococcus aureus (MRSA) is prevalent and consequential in cystic fibrosis (CF). Whole genome sequencing (WGS) could reveal genomic differences in MRSA associated with poorer outcomes or detect MRSA transmission. OBJECTIVES To identify MRSA genes associated with low lung function and potential MRSA transmission in CF. METHODS We collected 97 MRSA isolates from 74 individuals with CF from 2017 and performed short-read WGS. We determined sequence type (ST) and the phylogenetic relationship between isolates. We aligned accessory genes from 25 reference genomes to genome assemblies, classified isolates by accessory gene content, and correlated the accessory genome to clinical outcomes. RESULTS The most prevalent ST were ST5 (N = 55), ST8 (N = 15), and ST105 (N = 14). Closely related MRSA strains were shared by family members with CF, but rarely between unrelated individuals. Three clusters of MRSA were identified by accessory genome content. Cluster A, including ST5 and ST105, was highly prevalent at all ages. Cluster B, including ST8, was more limited to younger patients. Cluster C included 6 distantly related strains. Patients 20 years old and younger infected with Cluster A had lower forced expiratory volume in the first second (FEV1 ) and higher sputum biomass compared to similar-aged patients with Cluster B. CONCLUSIONS In this CF cohort, we identified MRSA subtypes that predominate at different ages and differ by accessory gene content. The most prevalent cluster of MRSA, including ST5 and ST105, was associated with lower FEV1 . ST8 MRSA was more common in younger patients and thus has the potential to rise in prevalence as these patients age.
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Affiliation(s)
- Harry S Porterfield
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Laboratory Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Lucas J Maakestad
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mason M LaMarche
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Andrew L Thurman
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Zoe E Kienenberger
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Nicholas J Pitcher
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alexis R Hansen
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Christian F Zirbes
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Linda Boyken
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Bethany L Muyskens
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alejandro A Pezzulo
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sachinkumar B Singh
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Erik Twait
- State Hygienic Laboratory at the University of Iowa, Iowa City, Iowa, USA
| | - Bradley Ford
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Valérie Reeb
- State Hygienic Laboratory at the University of Iowa, Iowa City, Iowa, USA
| | - Anthony J Fischer
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Abstract
Although survival of individuals with cystic fibrosis (CF) has been continuously improving for the past 40 years, respiratory failure secondary to recurrent pulmonary infections remains the leading cause of mortality in this patient population. Certain pathogens such as Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and species of the Burkholderia cepacia complex continue to be associated with poorer clinical outcomes including accelerated lung function decline and increased mortality. In addition, other organisms such as anaerobes, viruses, and fungi are increasingly recognized as potential contributors to disease progression. Culture-independent molecular methods are also being used for diagnostic purposes and to examine the interaction of microorganisms in the CF airway. Given the importance of CF airway infections, ongoing initiatives to promote understanding of the epidemiology, clinical course, and treatment options for these infections are needed.
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Affiliation(s)
- Ana C Blanchard
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Valerie J Waters
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis. Pediatr Infect Dis J 2019; 38:e285-e289. [PMID: 31568067 PMCID: PMC6802275 DOI: 10.1097/inf.0000000000002419] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In US cystic fibrosis (CF) patients, methicillin-resistant Staphylococcus aureus (MRSA) rates have tripled in the past 2 decades. Known clinical risk factors include exposure to a healthcare setting, Pseudomonas aeruginosa and CF-related diabetes. Area-level socio-environmental exposures have not been evaluated. We explored the association of area-level deprivation with MRSA prevalence in a pediatric CF Center in the Southeastern United States. METHODS Patients' residential addresses were geocoded and linked to a composite Area Deprivation Index and Rural-Urban Commuting Area scores. The association of MRSA with Area Deprivation Index and Rural-Urban Commuting Area scores was evaluated using logistic regression with robust standard errors adjusted for sociodemographic covariates (age, sex, race, mother's and father's education and household income), clinical risk factors (P. aeruginosa, CF-related diabetes, hospitalizations and number of clinic visits) and clustering. RESULTS The study included all pediatric patients (N = 231; mean age 12) at a single CF Center. MRSA was present in 44% of subjects. Higher area-level deprivation was correlated with rural residence, lack of parental college education and lower household income (P < 0.001 for each). In a multiple regression model fully adjusted for patient-level sociodemographic covariates, clinical risk factors and clustering, neighborhood deprivation was associated with more than 2-fold increase in the odds of having MRSA [OR 2.26 (1.14-4.45), P < 0.05]. CONCLUSIONS Neighborhood deprivation is a risk factor for MRSA in pediatric CF, doubling the odds of infection. Community-level socioeconomic risk factors should be considered when developing prevention strategies and treatment plans for MRSA infection in pediatric patients with CF.
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Singh SB, McLearn-Montz AJ, Milavetz F, Gates LK, Fox C, Murry LT, Sabus A, Porterfield HS, Fischer AJ. Pathogen acquisition in patients with cystic fibrosis receiving ivacaftor or lumacaftor/ivacaftor. Pediatr Pulmonol 2019; 54:1200-1208. [PMID: 31012285 PMCID: PMC6641998 DOI: 10.1002/ppul.24341] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/14/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The cystic fibrosis transmembrane conductance regulator (CFTR) modulators ivacaftor and lumacaftor/ivacaftor improve the status of existing infections in patients with cystic fibrosis (CF). It is unknown how well these drugs protect patients against incident infections. We hypothesized that CFTR modulator treatment would decrease new infections with Pseudomonas aeruginosa or Staphylococcus aureus. METHODS We retrospectively studied a single-center cohort of patients with CF during two time periods (2008-2011, Era 1) and (2012-2015, Era 2) based on the January 2012 approval of ivacaftor. Using Kaplan-Meier analysis, we compared the time to any new infection with P. aeruginosa, methicillin-resistant S. aureus (MRSA), or methicillin-sensitive S. aureus (MSSA) that was absent during a 2-year baseline. We stratified the analysis based on whether patients received ivacaftor or lumacaftor/ivacaftor during Era 2. We used the log-rank test and considered P < 0.05 statistically significant. RESULTS For patients receiving ivacaftor or lumacaftor/ivacaftor in Era 2, there was a statistically significant delay in the time to new bacterial acquisition in Era 2 vs. Era 1 ( P = 0.008). For patients who did not receive CFTR modulators, there was a trend toward slower acquisition of new bacterial infections in Era 2 compared to Era 1, but this was not statistically significant ( P = 0.10). CONCLUSIONS Patients receiving ivacaftor or lumacaftor/ivacaftor for CF had significantly delayed acquisition of P. aeruginosa and S. aureus after these drugs were released. This method for analyzing incident infections may be useful for future studies of CFTR modulators and bacterial acquisition in CF registry cohorts.
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Affiliation(s)
- Sachinkumar B Singh
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Amanda J McLearn-Montz
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Francesca Milavetz
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Levi K Gates
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Christopher Fox
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Logan T Murry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Ashley Sabus
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Harry S Porterfield
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Anthony J Fischer
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Cios K, Cohen B, Quittell LM, Liu J, Larson EL. Impact of colonizing organism in the respiratory tract on the incidence, duration, and time between subsequent hospitalizations among patients with cystic fibrosis. Am J Infect Control 2019; 47:750-754. [PMID: 30732978 DOI: 10.1016/j.ajic.2018.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study aimed to examine the association between colonizing respiratory tract organism and frequency, duration, and time between subsequent hospitalizations among hospitalized patients with cystic fibrosis (CF). METHODS This retrospective cohort study of 312 CF patients from 2 New York City hospitals (2006-2016) examined the effects of colonization with Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA), co-colonization on incidence of hospitalization, time to next hospitalization, and total length of stay (LOS). RESULTS Annual rate of subsequent hospitalizations was highest in patients with P aeruginosa: adjusted incidence rate ratios (aIRRs) were 2.75 (95% confidence interval [CI], 1.72-4.41) for P aeruginosa versus MSSA, 2.57 (95% CI, 1.52-4.31) for co-colonization versus MSSA, and 1.77 (95% CI, 1.04-3.01) for P aeruginosa versus MRSA. Time to readmission was shortest for P aeruginosa: aIRRs were 1.75 (95% CI, 1.05-2.94) for MRSA versus P aeruginosa, 1.64 (95% CI, 1.03-2.59) for MSSA versus P aeruginosa, and 1.61 (95% CI, 1.04-2.47) for co-colonization versus P aeruginosa. LOS was longest for P aeruginosa: aIRRs were 3.41 (95% CI, 2.19-5.32) for P aeruginosa versus MSSA, 1.66 (95% CI, 1.01-2.75) for co-colonization versus MSSA, 2.50 (95% CI, 1.58-3.93) for P aeruginosa versus MRSA, and 2.05 (95% CI, 1.32-3.18) for P aeruginosa versus co-colonization. CONCLUSIONS CF patients with P aeruginosa alone experienced more hospitalizations, longer LOS, and shorter time to readmission versus patients with S aureus or both organisms.
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Affiliation(s)
- Klaudia Cios
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Bevin Cohen
- School of Nursing, Columbia University, New York, NY.
| | - Lynne M Quittell
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; School of Nursing, Columbia University, New York, NY
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Pharmacokinetic Monitoring of Vancomycin in Cystic Fibrosis: Is It Time to Move Past Trough Concentrations? Pediatr Infect Dis J 2019; 38:258-262. [PMID: 29742643 DOI: 10.1097/inf.0000000000002088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A correlation between vancomycin (VAN) trough concentrations (VTC) and area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio (AUC/MIC) has not been established in children/adolescents with cystic fibrosis (CF). The primary objective of this study was to determine the correlation between measured VTCs and AUC/MIC using population-based pharmacokinetics. METHODS A retrospective cohort study of children/adolescents diagnosed with CF, 6 to <18 years of age, treated with VAN for methicillin-resistant Staphylococcus aureus infection was conducted. The relationship between final VTCs and calculated AUC/MIC was assessed using Pearson and Spearman correlations. All tests were 2-tailed with alpha set at 0.05. RESULTS Thirty children/adolescents, 7 to 17 years of age (median age 15 year; interquartile range: 9-17 years), were included. The mean final VAN dose was 58.03 ± 18.58 mg/kg/d, and the median final VTC was 12.6 (11-13.6) mg/L. The mean AUC/MIC was 355.34 ± 138.46 (Le model) versus 426.79 ± 178.92 (Stockmann model; P = 0.089). No correlation existed between VTCs and AUC/MIC using either the model by Le (r = 0.140; P = 0.461) or Stockmann (r = 0.115; P = 0.564). Using the Stockmann model, VAN dose (mg/kg/dose) was found to have a strong positive correlation with AUC (r = 0.8874; P < 0.0001) and AUC/MIC (r = 0.7877; P < 0.0001). CONCLUSIONS VTCs did not correlate with AUC or AUC/MIC. Further research is needed to determine which estimate of VAN treatment efficacy is most appropriate for children and adolescents with CF infected with methicillin-resistant Staphylococcus aureus.
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Akil N, Muhlebach MS. Biology and management of methicillin resistant Staphylococcus aureus in cystic fibrosis. Pediatr Pulmonol 2018; 53:S64-S74. [PMID: 30073802 DOI: 10.1002/ppul.24139] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus is one of the earliest bacteria isolated from the respiratory tract in people with cystic fibrosis (CF). Its methicillin resistant form, MRSA, has gained attention due to the rapid increase in the last decades and worse outcomes with chronic infection. In the United States, prevalence of MRSA in CF is around 27%, but is much lower (3-18%) in most other countries. Methicillin is typically genetically encoded by the mecA gene, which encodes for an alternative penicillin binding protein (PRBa). This PRBa has low affinity to β-lactams, thereby enabling growth of S. aureus in the presence of penicillinase resistant penicillins and most other β-lactams. Non-mecA positive strains of MRSA, so-called borderline resistant (BORSA) have also been described. In addition to production of toxins, the virulence of S. aureus is conferred by its adaptability allowing persistence in face of antibiotic therapies and host defense. These adaptive growth mechanisms include small colony variants, biofilms, and growth under anaerobic conditions. Several reports have described successful eradication of MRSA, yet only two randomized trials of eradication during early infection have been conducted. A list of MRSA specific antibiotics with dosing relevant to CF patients is presented here. Many of these require special dosing in people with CF. Novel antibiotics are in trials for skin and soft tissue infections and it is unclear if and when those might be available for lung infections. Thus the best strategies for MRSA would be primary prevention.
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Affiliation(s)
- Nour Akil
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina
| | - Marianne S Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina.,Marisco Lung Institute, University of NC at Chapel Hill, Chapel Hill, North Carolina
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12
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Genetic relatedness of Staphylococcus aureus isolates obtained from cystic fibrosis patients at a tertiary academic hospital in Pretoria, South Africa. Sci Rep 2018; 8:12222. [PMID: 30111773 PMCID: PMC6093922 DOI: 10.1038/s41598-018-30725-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023] Open
Abstract
Cystic fibrosis (CF) is an inherited recessive disease that affects mucocillary clearance in the lung, allowing it to be colonised with bacteria such as Staphylococcus aureus. To survive in the CF lung S. aureus adapts both phenotypically and genotypically, through various mechanisms. In this study, multiple specimens were collected from the participants and were processed routinely and were additionally cultured in chromogenic media. Multiplex PCR assays were employed to detect methicillin resistance and selected virulence and quaternary ammonium compound (qac) genes. Genetic relatedness of the S. aureus was determined using agr, SCCmec and spa typing as well as pulsed field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Thirty-three S. aureus isolates were isolated, of which 51% (17/33) were methicillin resistant S. aureus (MRSA). The virulence and qac genes were more prevalent in MRSA than the methicillin sensitive S. aureus (MSSA) isolates. The PFGE analysis showed nine distinct pulsotypes while MLST showed eight sequence types. All the STs detected in this study, except for ST508 have been previously isolated from CF patients according to the literature. This study showed a genetically diverse S. aureus population with a high prevalence of virulence genes among the MRSA isolates from the CF clinic.
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13
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Pena Amaya P, Haim MS, Fernández S, Di Gregorio S, Teper A, Vázquez M, Lubovich S, Galanternik L, Mollerach M. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in Cystic Fibrosis Patients from Argentina. Microb Drug Resist 2018; 24:613-620. [DOI: 10.1089/mdr.2017.0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Paula Pena Amaya
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Maria S. Haim
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
| | - Silvina Fernández
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
| | - Alejandro Teper
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Miryam Vázquez
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | - Silvina Lubovich
- Hospital de Niños “Dr. Ricardo Gutiérrez,” Buenos Aires, Argentina
| | | | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Microbiología, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
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14
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Wood ME, Stockwell RE, Johnson GR, Ramsay KA, Sherrard LJ, Kidd TJ, Cheney J, Ballard EL, O'Rourke P, Jabbour N, Wainwright CE, Knibbs LD, Sly PD, Morawska L, Bell SC. Cystic fibrosis pathogens survive for extended periods within cough-generated droplet nuclei. Thorax 2018; 74:87-90. [PMID: 29627800 DOI: 10.1136/thoraxjnl-2018-211567] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 01/21/2023]
Abstract
The airborne route is a potential pathway in the person-to-person transmission of bacterial strains among cystic fibrosis (CF) populations. In this cross-sectional study, we investigate the physical properties and survival of common non-Pseudomonas aeruginosa CF pathogens generated during coughing. We conclude that Gram-negative bacteria and Staphylococcus aureus are aerosolised during coughing, can travel up to 4 m and remain viable within droplet nuclei for up to 45 min. These results suggest that airborne person-to-person transmission is plausible for the CF pathogens we measured.
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Affiliation(s)
- Michelle E Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca E Stockwell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kay A Ramsay
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Laura J Sherrard
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Timothy J Kidd
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Joyce Cheney
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Emma L Ballard
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Peter O'Rourke
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nassib Jabbour
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Peter D Sly
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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15
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16
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Psoter KJ, De Roos AJ, Wakefield J, Mayer JD, Rosenfeld M. Air pollution exposure is associated with MRSA acquisition in young U.S. children with cystic fibrosis. BMC Pulm Med 2017; 17:106. [PMID: 28750627 PMCID: PMC5530959 DOI: 10.1186/s12890-017-0449-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/19/2017] [Indexed: 01/21/2023] Open
Abstract
Background The role of air pollution in increasing susceptibility to respiratory tract infections in the cystic fibrosis (CF) population has not been well described. We recently demonstrated that chronic PM2.5 exposure is associated with an increased risk of initial Pseudomonas aeruginosa acquisition in young children with CF. The purpose of this study was to determine whether PM2.5 exposure is a risk factor for acquisition of other respiratory pathogens in young children with CF. Methods We conducted a retrospective study of initial acquisition of methicillin susceptible and methicillin resistant Staphylococcus aureus (MSSA and MRSA), Stenotrophomonas maltophilia and Achromobacter xylosoxidans in U.S. children <6 years of age with CF using the CF Foundation Patient Registry, 2003–2009. Multivariable Weibull regression with interval-censored outcomes was used to evaluate the association of PM2.5 concentration in the year prior to birth and risk of acquisition of each organism. Results During follow-up 63%, 17%, 24%, and 5% of children acquired MSSA, MRSA, S. maltophilia, and A. xylosoxidans, respectively. A 10 μg/m3 increase in PM2.5 exposure was associated with a 68% increased risk of MRSA acquisition (Hazard Ratio: 1.68; 95% Confidence Interval: 1.24, 2.27). PM2.5 was not associated with acquisition of other respiratory pathogens. Conclusions Fine particulate matter is an independent risk factor for initial MRSA acquisition in young children with CF. These results support the increasing evidence that air pollution contributes to pulmonary morbidities in the CF community.
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Affiliation(s)
- Kevin J Psoter
- Department of Pediatrics, School of Medicine, The Johns Hopkins University Bayview Medical Center, 5200 Eastern Ave, Mason F. Lord Bldg, Center Towers, Suite 4200, Baltimore, MD, 21224, USA.
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Jon Wakefield
- Departments of Biostatistics and Statistics, University of Washington, Seattle, WA, USA
| | - Jonathan D Mayer
- Departments of Epidemiology, Geography, Global Health, Medicine (Allergy and Infectious Diseases), Family Medicine, and Health Services, University of Washington, Seattle, WA, USA
| | - Margaret Rosenfeld
- Division of Pulmonary Medicine, University of Washington School of Medicine, Seattle, WA, USA
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17
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Abstract
The earliest descriptions of lung disease in people with cystic fibrosis (CF) showed the involvement of 3 interacting pathophysiologic elements in CF airways: mucus obstruction, inflammation, and infection. Over the past 7 decades, our understanding of CF respiratory microbiology and inflammation has evolved with the introduction of new treatments, increased longevity, and increasingly sophisticated laboratory techniques. This article reviews the current understanding of infection and inflammation and their roles in CF lung disease. It also discusses how this constantly evolving information is used to inform current therapeutic strategies, measures and predictors of disease severity, and research priorities.
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Affiliation(s)
- Edith T Zemanick
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B-395, Aurora, CO 80045, USA
| | - Lucas R Hoffman
- Departments of Pediatrics and Microbiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, MS OC.7.720, Seattle, WA 98105, USA.
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18
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Harik NS, Com G, Tang X, Melguizo Castro M, Stemper ME, Carroll JL. Clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis from a center with a high MRSA prevalence. Am J Infect Control 2016; 44:409-15. [PMID: 26684366 DOI: 10.1016/j.ajic.2015.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/10/2015] [Accepted: 10/16/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe the clinical characteristics and epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in children with cystic fibrosis (CF) from the U.S. CF center with the highest MRSA prevalence. METHODS Medical records of children with CF were retrospectively reviewed from 1997-2009. MRSA clinical isolates from 2007-2009 were analyzed by polymerase chain reaction and pulsed field gel electrophoresis. RESULTS The prevalence of MRSA was 1% in 1997 and 49% in 2009. Fifty-five children (26%) had persistent MRSA infection. Sixty-eight percent of MRSA isolates were hospital-associated (HA) MRSA, of which 52% were pulsed-field type USA 100. Ninety-three percent of HA MRSA isolates were clindamycin resistant. Twelve children acquired MRSA before 1 year of age, 83% of whom were hospitalized prior to acquisition of MRSA. Ten of 11 sibling pairs carried indistinguishable MRSA strains. Children with persistent MRSA were hospitalized more often (P = .01), required inhaled medications more frequently (P = .01), and had higher rates of Pseudomonas aeruginosa coinfection (P < .001). CONCLUSION MRSA prevalence in children with CF is increasing, and most children are infected with HA MRSA. Exposure to health care facilities and gastrointestinal surgeries may facilitate early acquisition of MRSA. Siblings carry indistinguishable MRSA strains, indicating household transmission of MRSA. Children with persistent MRSA had worse pulmonary morbidity. Coinfection with MRSA and P aeruginosa is likely associated with further increased pulmonary morbidity.
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Affiliation(s)
- Nada S Harik
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Gulnur Com
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Xinyu Tang
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Maria Melguizo Castro
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - John L Carroll
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
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19
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Firmida MC, Pereira RHV, Silva EASR, Marques EA, Lopes AJ. Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis. Braz J Med Biol Res 2016; 49:e5097. [PMID: 26909788 PMCID: PMC4792508 DOI: 10.1590/1414-431x20155097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/17/2015] [Indexed: 12/20/2022] Open
Abstract
The rate of diagnosis of colonization/infection of the airways with
Achromobacter xylosoxidans has increased in cystic fibrosis
patients, but its clinical significance is still controversial. This retrospective,
case-control study aimed to evaluate the clinical impact of A.
xylosoxidans colonization/infection in cystic fibrosis patients.
Individuals who were chronically colonized/infected (n=10), intermittently
colonized/infected (n=15), and never colonized/infected with A.
xylosoxidans (n=18) were retrospectively evaluated during two
periods that were 2 years apart. Demographic characteristics, clinical data, lung
function, and chronic bacterial co-colonization data were evaluated. Of the total
study population, 87% were pediatric patients and 65.1% were female. Individuals
chronically colonized/infected with A. xylosoxidans had decreased
forced expiratory volume in 1 s (51.7% in the chronic colonization/infection group
vs 82.7% in the intermittent colonization/infection group
vs 76% in the never colonized/infected group). Compared with the
other two groups, the rate of co-colonization with methicillin-resistant
Staphylococcus aureus was higher in individuals chronically
colonized/infected with A. xylosoxidans (P=0.002).
Changes in lung function over 2 years in the three groups were not significant,
although a trend toward a greater decrease in lung function was observed in the
chronically colonized/infected group. Compared with the other two groups, there was a
greater number of annual hospitalizations in patients chronically colonized/infected
with A. xylosoxidans (P=0.033). In cystic fibrosis patients, there
was an increased frequency of A. xylosoxidans colonization/infection
in children, and lung function was reduced in patients who were chronically
colonized/infected with A. xylosoxidans. Additionally, there were no
differences in clinical outcomes during the 2-year period, except for an increased
number of hospitalizations in patients with A. xylosoxidans.
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Affiliation(s)
- M C Firmida
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R H V Pereira
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - E A S R Silva
- Laboratório de Bacteriologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - E A Marques
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A J Lopes
- Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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20
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Hector A, Kirn T, Ralhan A, Graepler-Mainka U, Berenbrinker S, Riethmueller J, Hogardt M, Wagner M, Pfleger A, Autenrieth I, Kappler M, Griese M, Eber E, Martus P, Hartl D. Microbial colonization and lung function in adolescents with cystic fibrosis. J Cyst Fibros 2016; 15:340-9. [PMID: 26856310 DOI: 10.1016/j.jcf.2016.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/24/2016] [Accepted: 01/24/2016] [Indexed: 11/18/2022]
Abstract
With intensified antibiotic therapy and longer survival, patients with cystic fibrosis (CF) are colonized with a more complex pattern of bacteria and fungi. However, the clinical relevance of these emerging pathogens for lung function remains poorly defined. The aim of this study was to assess the association of bacterial and fungal colonization patterns with lung function in adolescent patients with CF. Microbial colonization patterns and lung function parameters were assessed in 770 adolescent European (German/Austrian) CF patients in a retrospective study (median follow-up time: 10years). Colonization with Pseudomonas aeruginosa and MRSA were most strongly associated with loss of lung function, while mainly colonization with Haemophilus influenzae was associated with preserved lung function. Aspergillus fumigatus was the only species that was associated with an increased risk for infection with P. aeruginosa. Microbial interaction analysis revealed three distinct microbial clusters within the longitudinal course of CF lung disease. Collectively, this study identified potentially protective and harmful microbial colonization patterns in adolescent CF patients. Further studies in different patient cohorts are required to evaluate these microbial patterns and to assess their clinical relevance.
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Affiliation(s)
- Andreas Hector
- Children's Hospital of the University of Tübingen, Tübingen, Germany
| | - Tobias Kirn
- Children's Hospital of the University of Tübingen, Tübingen, Germany
| | - Anjali Ralhan
- Children's Hospital of the University of Tübingen, Tübingen, Germany
| | | | - Sina Berenbrinker
- Children's Hospital of the University of Tübingen, Tübingen, Germany
| | | | - Michael Hogardt
- Institute of Medical Microbiology and Hygiene, University of Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Pfleger
- Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Ingo Autenrieth
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany; German Center for Infection Research (DZIF), partner site Tübingen, Tübingen, Germany
| | - Matthias Kappler
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians University, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Matthias Griese
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians University, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Ernst Eber
- Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Dominik Hartl
- Children's Hospital of the University of Tübingen, Tübingen, Germany.
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21
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Abstract
Observations from studies during the last decade have changed the conventional view of cystic fibrosis (CF) microbiology, which has traditionally focused on a limited suite of opportunistic bacterial pathogens. It is now appreciated that CF airways typically harbor complex microbial communities, and that changes in the structure and activity of these communities have a bearing on patient clinical condition and lung disease progression. Recent studies of gut microbiota also suggest that disordered bacterial ecology of the CF gastrointestinal tract is associated with pulmonary outcomes. These new insights may alter future clinical management of CF.
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Affiliation(s)
- Yvonne J Huang
- Division of Pulmonary/Critical Care Medicine, University of Michigan Medical School, 6301 MSRB III/SPC 5642, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - John J LiPuma
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, 8323 MSRB III/SPC 5646, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA
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