Exacerbations in cystic fibrosis {middle dot} 1: Epidemiology and pathogenesis

Goss, Christopher H.; Burns, Jane L.

doi:10.1136/thx.2006.060889

Cited by 395 publications

(376 citation statements)

References 118 publications

Supporting

Mentioning

368

Contrasting

Unclassified

Order By: Relevance

“…Combinations of ticarcillin/clavulanate plus aztreonam have been reported by other workers as having synergistic activity against S. maltophilia (4,11,14) and have proved to be our most synergistic combination to date. The resistance of S. maltophilia to ␤-lactam antimicrobials is due to the expression of two ß-lactamases, L1 and L2.…”

Section: Discussionmentioning

confidence: 73%

“…It is widely reported in the literature that S. maltophilia is increasingly being isolated from the airways of individuals with CF, and the cause and effect are still being debated (3,4,11,13). One thing agreed, however, is that the multidrug-resistant nature of S. maltophilia poses problems for the clinician in the selection of appropriate antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The high rate of resistance found in this study serves to underline the resistant nature of S. maltophilia present in the Scottish CF population. Co-trimoxazole, ticarcillin/clavulanate, minocycline, doxycycline, levofloxacin, and chloramphenicol have all been reported as being the most active single agent against S. maltophilia isolated from individuals with and without CF (6,9,11,18,22,27,29). Co-trimoxazole is often the drug of first choice for therapy, although increasing in vitro resistance is being reported (2,9,14).…”

Section: Discussionmentioning

confidence: 99%

“…This organism can be the cause of respiratory, urinary, and bloodstream infections in hospitalized patients, especially in those who are immumocompromised or are in intensive care units and particularly in those patients who are catheterized or are receiving mechanical ventilation (22,29). It has recently been shown to be a risk factor for pulmonary exacerbation in CF, but the role it plays in the decline of lung function is unclear (3,11,13,30). Reports suggest that S. maltophilia acquisition in CF occurs in individuals who are older, have poorer lung function, and have advanced lung disease and that its detection does not independently affect short-term survival, that long-term chronic infection is unusual, and that accelerated deterioration in lung function is unlikely (12).…”

mentioning

confidence: 99%

See 3 more Smart Citations

Combination Antimicrobial Susceptibility Testing of Multidrug-Resistant Stenotrophomonas maltophilia from Cystic Fibrosis Patients

Milne

Gould

2012

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Stenotrophomonas maltophilia is increasingly being isolated from the respiratory tract of individuals with cystic fibrosis, and, because of its multidrug-resistant nature, the selection of suitable treatment regimens can be problematical. Etest methodology was used to facilitate MIC and antimicrobial combination testing on 80 isolates of S. maltophilia cultured from the respiratory tract of Scottish individuals with cystic fibrosis between 2001 and 2010. The overall rate of susceptibility for the 1,410 MIC tests was 23.1%, and resistance was 68.9%. The most active antimicrobials were minocycline, co-trimoxazole, and doxycycline, with 92.4%, 87.3%, and 58.8% of isolates being susceptible, respectively. Of the 517 combinations, 13.2% were synergistic, with the most synergistic being ticarcillin/clavulanate plus aztreonam (91.7% synergistic), ticarcillin/clavulanate plus colistin (40%), and ticarcillin/clavulanate plus levofloxacin (19.4%). Colistin plus tobramycin was the only antagonistic combination (0.2%). By the median susceptible breakpoint index, the most active combinations were minocycline plus co-trimoxazole (median index, 20), minocycline plus piperacillin-tazobactam (median, 20), and co-trimoxazole plus ceftazidime (median, 16.5). The increasing problem of multidrug resistance in organisms recovered from the respiratory tracts of individuals with cystic fibrosis is not going to go away. Current susceptibility testing methods do not address the slow-growing organisms associated with chronic infection, and interpretive standards are based on achievable blood levels of antimicrobials. Addressing these issues specifically for organisms recovered from the respiratory tracts of individuals with cystic fibrosis should lead to better therapeutic outcomes and improved wellbeing of individuals with cystic fibrosis.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Combination Antimicrobial Susceptibility Testing of Multidrug-Resistant Stenotrophomonas maltophilia from Cystic Fibrosis Patients

Milne

Gould

2012

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Patients were considered eligible if they had a diagnosis of CF confirmed by clinical criteria and sweat testing or genotype analysis, were Ն 18 years old, and had been clinically stable for the past 2 weeks (no signs or symptoms of an exacerbation, such as increased cough, change in sputum, decreased appetite or weight, change in respiratory examination or respiratory rate). 12 Participants were excluded if they had any comorbidities that prevented exercise testing (eg, unstable cardiac disease, or severe musculoskeletal or neurological impairments affecting the lower limbs).…”

Section: Methodsmentioning

confidence: 99%

Desaturation During the 3-Minute Step Test Predicts Impaired 12-Month Outcomes in Adult Patients With Cystic Fibrosis

et al. 2011

View full text Add to dashboard Cite

BACKGROUND:The 3-minute step test is a simple test of exercise capacity for children with cystic fibrosis (CF), but no data have been reported regarding its usefulness in adults or its prognostic value. OBJECTIVE: To determine the feasibility and acceptability of the 3-minute step test as a test of exercise capacity in adults with CF and whether test performance is associated with 12-month clinical outcomes. METHODS: From our out-patient clinic we prospectively recruited consecutive adult patients with CF in stable health. The 3-minute step test was conducted with a standardized protocol that included a 15-cm high step and external pacing at 30 steps/min. We measured heart rate, dyspnea, and S pO 2 . With multiple linear regression analyses we assessed the relationships between step-test performance and change in FEV 1 and hospital days at 12 months. RESULTS: The participants were 101 adults: 56 male, mean ؎ SD age 29 ؎ 9 years, percent-of-predicted FEV 1 61 ؎ 23%, body mass index 22 ؎ 4 kg/m 2 . Only 42% of the participants with mild CF achieved 70% of the predicted maximum heart rate during the 3-minute step test, compared to 77% of those with FEV 1 < 60% of predicted. The 22 patients who desaturated to < 90% during the 3-minute step test had a larger number of hospital days over the following 12 months than did those who did not (median 28 d vs 11 d, P < .001). Those who desaturated also had a greater FEV 1 decline (mean difference ؊117 mL, 95% CI ؊215 to ؊19 mL). Desaturation during the 3-minute step test was an independent predictor of both FEV 1 decline and days spent in hospital. CONCLUSIONS: Desaturation during the 3-minute step test is associated with long-term pulmonary deterioration and more hospital days in adults with CF. The 3-minute step test may be a useful screening test for patients with moderate to severe CF lung disease, who require increased intervention and monitoring.

show abstract