Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

Firmida, M C; Pereira, Rosana Helena Vicente; Silva, E.A.S.R.; Marques, Elizabeth Andrade; Lopes, Agnaldo José

doi:10.1590/1414-431x20155097

Cited by 33 publications

(33 citation statements)

References 31 publications

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“…No microbial factors influenced the risk of progression to persistence. The significance of the larger proportion of persistently infected patients with chronic S. aureus infection, which was also observed previously (26), is unclear. Uniquely, we observed that ICS were associated with the risk of persistence, in contrast to transient infections or controls.…”

Section: Discussionmentioning

confidence: 69%

“…Coinfection with P. aeruginosa (2,17,19,27) is common due to increased exposure to antibiotics for chronic infection (26). The rate of persistent infection in our population was high, at 29%, likely due to a less stringent definition (25).…”

Section: Discussionmentioning

confidence: 74%

“…Despite the increasingly frequent isolation of Achromobacter from CF patients, its pathogenicity is unclear (11,12,26), though the growing body of evidence seems to support the significance of its isolation (17,37,38). Although PEx in CF patients are common, we hypothesized a discernible clinical impact with subsequent lung function decline after Achromobacter detection.…”

Section: Discussionmentioning

confidence: 93%

“…Rates of chronic infection have typically ranged from 3 to 12% of incident Achromobacter infections (5,24,25), again with the risk factors of older age and the burden of lung disease (11,26). Coinfection with P. aeruginosa (2,17,19,27) is common due to increased exposure to antibiotics for chronic infection (26).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

et al. 2017

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Achromobacter species are increasingly being detected in cystic fibrosis (CF) patients, with an unclear epidemiology and impact. We studied a cohort of patients attending a Canadian adult CF clinic who had positive sputum cultures for Achromobacter species in the period from 1984 to 2013. Infection was categorized as transient or persistent (Ն50% positive cultures for 1 year). Those with persistent infection were matched 2:1 with age-, sex-, and time-matched controls without a history of Achromobacter infection, and mixed-effects models were used to assess pulmonary exacerbation (PEx) frequency and lung function decline. Isolates from a biobank were retrospectively assessed, identified to the species level by nrdA sequencing, and genotyped using pulsed-field gel electrophoresis (PFGE). Thirty-four patients (11% of those in our clinic), with a median age of 24 years (interquartile range [IQR], 20.3 to 29.8 years), developed Achromobacter infection. Ten patients (29%) developed persistent infection. Persistence did not denote permanence, as most patients ultimately cleared infection, often after years. Patients were more likely to experience PEx at incident isolation than at prior or subsequent visits (odds ratio [OR], 2.7 [95% confidence interval {CI}, 1.2 to 6.7]; P ϭ 0.03). Following persistent infection, there was no difference in annual lung function decline (Ϫ1.08% [95% CI, Ϫ2.73 to 0.57%] versus Ϫ2.74% [95% CI, Ϫ4.02 to 1.46%]; P ϭ 0.12) or the odds of PEx (OR, 1.21 [95% CI, 0.45 to 3.28]; P ϭ 0.70). Differential virulence among Achromobacter species was not observed, and no cases of transmission occurred. We demonstrated that incident Achromobacter infection was associated with a greater risk of PEx; however, neither transient nor chronic infection was associated with a worsened long-term prognosis. Large, multicenter studies are needed to clarify the clinical impact, natural history, and transmissibility of Achromobacter.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

et al. 2017

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“…nov. [2]. The most prevalent species in CF using discriminative molecular tools is Achromobacter xylosoxidans , which has been associated with increased lung inflammation [3], more frequent CF exacerbations, and more severe lung disease [4], [5]. However, evidence of the clinical relevance of these species remains controversial [6].…”

Section: Introductionmentioning

confidence: 99%

Achromobacter xylosoxidans infection in cystic fibrosis siblings with different outcomes: Case reports

Firmida

Marques

Leão

et al. 2017

Respiratory Medicine Case Reports

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IntroductionThe clinical relevance of Achromobacter xylosoxidans infection in cystic fibrosis (CF) remains controversial. This emerging agent in CF has been associated with increased lung inflammation, more frequent exacerbations and more severe lung disease. We describe a pair of CF siblings chronically colonized by the same multilocus genotype of A. xylosoxidans with different clinical courses, and assess whether this species may have developed any virulence traits and antimicrobial resistance that could have contributed to their singular outcomes.Case presentationTwo siblings were positive for the F508del and Y1092X mutations, and were chronically colonized by Pseudomonas aeruginosa and Staphylococcus aureus. The female patient had a more severe CF phenotype and faster clinical deterioration than her brother. Her pulmonary function and computed tomography scan lesions were worse than those of her brother, and both parameters progressively declined. She died at 14 years of age, when he was 18. All isolates of A. xylosoxidans were biofilm producers. Achromobacter xylosoxidans showed less swarming motility in the female patient.ConclusionsBiofilm production and diminution of motility allow persistence. Only swarming motility differed between the isolates recovered from the two siblings, but this finding is not sufficient to explain the different clinical outcomes despite their similar genotypes. Modifier genes, unknown environmental factors and female gender can partially explain differences between these siblings. We were unable to correlate any microbiological findings with their clinical courses, and more translational studies are necessary to decrease the gap of knowledge between laboratory and clinical data to promote better clinical interventions.

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Cystic fibrosis year in review 2016

Savant

McColley

2017

Pediatr Pulmonol

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Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

Cited by 33 publications

References 31 publications

Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

Achromobacter xylosoxidans infection in cystic fibrosis siblings with different outcomes: Case reports

Cystic fibrosis year in review 2016

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