This study aims to examine the association between the numbers of culturable microbial species forming the microflora of the lung in patients with cystic fibrosis (CF) and microbial loading (i.e., type[s] versus numbers). Additionally, it examines qualitative combinations of the microflora present in a large adult CF centre (n=138) in order to ascertain ecological relationships between the taxa present. The culturable microflora of sputum from 34 adults patients with CF are enumerated using a spread plate technique on non-selective agar, and the microflora identified phenotypically employing the API 20NE scheme. Microbiological examination of the 34 adult patients demonstrated that their sputum contained between one and three taxa, with a mean cell density of 8.25 +/- 0.85 log colony-forming units (cfu)/g sputum and a range of 5.91-9.74 log cfu/g sputum. Most colonising patterns demonstrated only Gram-negative infection (22/34), followed by a mixed Gram-positive/Gram-negative infection pattern (10/34). Only 2/34 patients had a single Gram-positive infection. Most patients (53%) were colonised by only one organism, with 38% of patients colonised by two organisms, and the remainder (4%) colonised with three organisms. There was no statistical difference (P>0.05) between microbial cell density and the number of taxa present (i.e., the greater number of taxa present in sputum did not produce a higher cell density). However, there was a significantly higher cell density (log 0.59 cfu/g sputum) noted for those patients who had only Gram-negative infection, compared to those who had a mixed Gram-negative/Gram-positive infection pattern (P=0.02). Relatively little is known about the ecological interactions that exist between the microflora in the CF lung. Further work is required to explore these interactions in order to aid understanding of the succession and dominance of Gram-negatives in chronic chest infections. Ultimately, a greater understanding of such interactions may allow the opportunity to manipulate the ecology of the lung to control otherwise problematic pathogens
Introduction and objectivesBTS guidelines recommend to try and eradicate Pseudomonas aeruginosa when first isolated from patients with non-CF bronchiectasis. The aims of this study were to 1) define the different eradication regimens used in our respiratory centre and 2) evaluate their efficacy.MethodsThe medical notes of adult non-CF bronchiectasis patients who underwent eradication trial for P. aeruginosa, between 2007 and 2014, were retrospectively reviewed. Eradication was considered successful if all (and at least 3) respiratory samples collected during the 6-month period following initiation of eradication were free of P. aeruginosa.ResultsDuring the study period, 67 patients (58% male, average age 63.0 yrs) had at least one eradication trial. The majority of regimens used combined nebulised colomycin with either oral ciprofloxacin or intravenous antipseudomonal antibiotics as first line therapy, (Table 1, n = 57; 85%). Overall, first eradication attempts were successful in 52% of cases (35/67). Regimens including nebulised colomycin were more effective (n = 23/38; 60%) than those without it (20%; 2/10) (Fisher`s exact test, p = 0.04). Longer courses of ciprofloxacin (>3 weeks) did not improve outcome in comparison with shorter (≤3 weeks) courses (p = NS). Furthermore, intravenous antibiotics were not superior to oral ciprofloxacin (p = NS). Amongst the 32 patients who failed to eradicate P. aeruginosa in the first instance, 20 underwent a second attempt. In comparison with first trials, overall success rate of second trials decreased to 35% (n = 7/20). However, this difference did not reach statistical significance (Fisher`s exact test, p = 0.3). Nineteen patients, who initially successfully cleared P. aeruginosa, required a 2nd eradication trial later during the study period. For those patients, the eradication success was 53%, comparable to the first one.Abstract S115 Table 1Frequency and efficacy of antibiotics used as first-line eradication regimensTreatmentNebulised colomycin (3 months) &No nebulised colomycinCipro (≤3 weeks)Cipro (>3 weeks)IVs(2 weeks)Cipro + IVsNil elseCiproIVsCipro + IVsPatients, n 9291351622Success, n (%)6 (67)17 (59)7 (54)2 (40)1 (100)1 (17)0 (0)1 (50)Cipro: Ciprofloxacin; IVs: intravenous antipseudomonal antibiotics.ConclusionsEradication regimens combining systemic and nebulised antibiotics appear more effective than systemic antibiotics alone to achieve P. aeruginosa eradication in non-CF bronchiectasis patients.
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