Comparison of respiratory pathogen colonization and antimicrobial susceptibility in people with cystic fibrosis versus non cystic fibrosis bronchiectasis: A systematic review

Abstract

Background Both cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis are characterized by permanent bronchial dilation, leading to impaired mucociliary clearance and development of chronic infections. Although the core airway microbiota in both CF and non-CF bronchiectasis may be similar, particular satellite microbes are associated with specific conditions. Moreover, there are several factors, which may be responsible for the disparity in antibiotic susceptibility profile between the CF and non-CF populations. Hence comparing the microbiota and antibiotic susceptibility pattern in CF bronchiectasis with non-CF bronchiectasis would aid in improved management of both the conditions. Methods Two authors will independently search the electronic databases PubMed and EMBASE for studies reporting bacterial colonization of the respiratory tract determined by examination of any respiratory tract specimen, by conventional bacterial culture or specialized techniques; and/or antimicrobial susceptibility testing in adults and children diagnosed with bronchiectasis in either CF subjects or non-CF subjects. The authors will independently assess the risk of bias for each included study using the Newcastle Ottawa Scale (NOS). We will present the data with descriptive statistics and provide pooled estimates of outcome parameters, wherever it is feasible to perform meta-analysis using a random effects model. Heterogeneity in studies will be explored by visual inspection of forest plot as well as using the Higgins and Thompson I2 method. We will contact the corresponding authors of studies where data is/are missing and try to obtain the missing data. Discussion To date, there are no locally applicable evidence-based guidelines for antimicrobial treatment of non-CF bronchiectasis patients. In general, treatment in non-CF bronchiectasis is based on extrapolation of clinical trials done in subjects with CF bronchiectasis. An insight into the microbiota and antimicrobial susceptibility patterns against specific organisms in both the conditions would facilitate appropriate rather than empiric therapy, and hopefully reduce the burden of antimicrobial resistance created by rampant usage of antibiotics. Therefore, this systematic review is being undertaken to compare the respiratory tract colonization and antibacterial susceptibility pattern in people with cystic fibrosis versus non-cystic fibrosis bronchiectasis. Systematic review registration: The protocol was submitted for publication in PROSPERO on June 26, 2020 (PROSPERO ID: 193859).