Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis

Hewer, Simon C Langton; Smyth, Alan

doi:10.1002/14651858.cd004197.pub3

Cited by 84 publications

(85 citation statements)

References 52 publications

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“…In contrast, compelling evidence of a clinical benefit in CF with early intervention is very scarce [3], and it has been suggested that young CF patients with early infection with P. aeruginosa often have minimal symptoms and mild lung disease, which may lead to insensitive outcome measures [35]. …”

Section: Discussionmentioning

confidence: 99%

“…Early detection of infection with P. aeruginosa in patients with CF may be important as certain antibiotic treatments have proven useful in preventing or delaying chronic bronchial infection with P. aeruginosa [2]. Although the most effective treatment has yet to be determined, eradication of P. aeruginosa seems more likely using strategies with nebulised antibiotics [3]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Eradication Therapy against Pseudomonas aeruginosa in Non-Cystic Fibrosis Bronchiectasis

Orriols

Hernando²,

Ferrer³

et al. 2015

Respiration

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Background: No prospective study has assessed eradication treatment of early Pseudomonas aeruginosa colonisation in bronchiectasis not due to cystic fibrosis (CF). Objectives: To evaluate the efficacy of 3 months of nebulised tobramycin after a short course of intravenous antibiotics in the eradication of P. aeruginosa and its clinical consequences in non- CF bronchiectasis following initial P. aeruginosa infection. Methods: A 15-month, single-masked, randomised study including 35 patients was conducted in a tertiary university hospital. Following the isolation of P. aeruginosa and a 14-day intravenous treatment with ceftazidime and tobramycin, patients received 300 mg nebulised tobramycin twice daily or placebo during 3 months, and were followed up for 12 months thereafter. Results: The median time to recurrence of P. aeruginosa infection was higher in the tobramycin than in the placebo group (p = 0.048, log-rank test). At the end of the study 54.5% of the patients were free of P. aeruginosa in the tobramycin group and 29.4% in the placebo group. The numbers of exacerbations (p = 0.044), hospital admissions (p = 0.037) and days of hospitalisation (p = 0.034) were lower in the tobramycin than in the placebo group. A global, non-significant trend to improvement in the tobramycin group was observed in most of the other studied parameters on comparing the two groups. Bronchospasm in the tobramycin group was remarkable. Conclusions: Our study shows that 3 months of nebulised tobramycin following a short course of intravenous antibiotics may prevent bronchial infection with P. aeruginosa and has a favourable clinical impact on non-CF bronchiectasis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eradication Therapy against Pseudomonas aeruginosa in Non-Cystic Fibrosis Bronchiectasis

Orriols

Hernando²,

Ferrer³

et al. 2015

Respiration

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“…P. aeruginosa infection has been associated with 48 : Worse lung function outcomesHigher respiratory tract inflammationA greater risk of respiratory exacerbationsHigher risk of mortality…”

Section: Cf Microbiologymentioning

confidence: 99%

Cystic Fibrosis

Zemanick

Hoffman

2016

Pediatric Clinics of North America

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THE EARLIEST DESCRIPTIONS OF LUNG DISEASE IN PEOPLE WITH CYSTIC FIBROSIS (CF) DEMONSTRATED THE INVOLVEMENT OF THREE INTERACTING PATHOPHYSIOLOGICAL 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, WITH INCREASED LONGEVITY, AND WITH INCREASINGLY SOPHISTICATED LABORATORY TECHNIQUES. IN THIS CHAPTER, WE WILL REVIEW THE CURRENT STATE OF UNDERSTANDING OF THE ROLES OF INFECTION AND INFLAMMATION AND THEIR ROLES IN DRIVING LUNG DISEASE. WE WILL ALSO DISCUSS 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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“…This can be prevented by early detection and treatment [3, 4]. As a significant proportion of patients with new P. aeruginosa infection remain asymptomatic [5], microbiological surveillance is vital to ensure that it is not missed.…”

Section: Introductionmentioning

confidence: 99%

Exhaled breath hydrogen cyanide as a marker of earlyPseudomonas aeruginosainfection in children with cystic fibrosis

Gilchrist

Belcher

Jones³

et al. 2015

ERJ Open Res

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Hydrogen cyanide is readily detected in the headspace above Pseudomonas aeruginosa cultures and in the breath of cystic fibrosis (CF) patients with chronic (P. aeruginosa) infection. We investigated if exhaled breath HCN is an early marker of P. aeruginosa infection.233 children with CF who were free from P. aeruginosa infection were followed for 2 years. Their median (interquartile range) age was 8.0 (5.0–12.2) years. At each study visit, an exhaled breath sample was collected for hydrogen cyanide analysis. In total, 2055 breath samples were analysed. At the end of the study, the hydrogen cyanide concentrations were compared to the results of routine microbiology surveillance.P. aeruginosa was isolated from 71 children during the study with an incidence (95% CI) of 0.19 (0.15–0.23) cases per patient-year. Using a random-effects logistic model, the estimated odds ratio (95% CI) was 3.1 (2.6–3.6), which showed that for a 1- ppbv increase in exhaled breath hydrogen cyanide, we expected a 212% increase in the odds of P. aeruginosa infection. The sensitivity and specificity were estimated at 33% and 99%, respectively.Exhaled breath hydrogen cyanide is a specific biomarker of new P. aeruginosa infection in children with CF. Its low sensitivity means that at present, hydrogen cyanide cannot be used as a screening test for this infection.

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Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis

Cited by 84 publications

References 52 publications

Eradication Therapy against <b><i>Pseudomonas aeruginosa</i></b> in Non-Cystic Fibrosis Bronchiectasis

Eradication Therapy against <b><i>Pseudomonas aeruginosa</i></b> in Non-Cystic Fibrosis Bronchiectasis

Cystic Fibrosis

Exhaled breath hydrogen cyanide as a marker of earlyPseudomonas aeruginosainfection in children with cystic fibrosis

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