Inhaled anti-pseudomonal antibiotics for long-term therapy in cystic fibrosis

Smith, Sherie; Rowbotham, Nicola J.

doi:10.1002/14651858.cd001021.pub4

Cited by 14 publications

(16 citation statements)

References 191 publications

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“…Once chronically colonized, efforts should be directed toward suppressing the infection. Clinical studies have shown that inhaled antibiotics improved pulmonary function and reduced the rate of exacerbations in patients already infected with P. aeruginosa 23,24 . All of our patients used long‐term inhaled antipseudomonal antibiotics.…”

Section: Discussionmentioning

confidence: 87%

The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis

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Emiralioğlu

et al. 2022

Pediatrics International

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Background Chronic Pseudomonas aeruginosa colonization (Pa‐CC) affects cystic fibrosis (CF) progression, including pulmonary exacerbations and pulmonary function tests. There are few studies of the effects of eradication protocols on colonization time. Here, we aimed to evaluate the effect of eradication regimens on chronic colonization and assess the impact of Pa‐CC on body mass index, lung functions, and pulmonary exacerbations. Methods A retrospective review was conducted of medical records, over a period of 11 years, of children aged under 18 years with CF who had Pa‐CC in our tertiary care pediatric hospital. Results Pseudomonas aeruginosa was detected in 215 of our patients with CF during the study period. Forty‐four patients with Pa‐CC were recruited for the study. The eradication treatment for the initial acquisition of P. aeruginosa was inhaled antibiotics in 27 (61.4%) patients; the remainder were given intravenous antibiotics. It was observed that eradication treatment with either IV or inhaled antibiotics did not affect the time between the P. aeruginosa and the time of Pa‐CC(P = 0.791). There was a non‐significant decrease in the body mass index z‐score from the Pa‐IA to the last visit(P = 0.27), a significant decline in forced expiratory volume in 1 s (FEV1%) (P = 0.01) over time, and the annual number of exacerbations after colonization was significantly higher than before colonization (P = 0.03). Conclusions There was no difference between eradication regimens in delaying the age at Pa‐CC. Pseudomonas aeruginosa colonization in patients with CF was also associated with poorer lung functions, lower body mass index, and more pulmonary exacerbation regardless of mucoid type. Consequently, to slow the progression of lung disease, we must prevent Pa‐CC, which we can achieve with early eradication. Despite conventional eradication protocols, future studies need to evaluate those who fail to clear P. aeruginosa.

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Section: Discussionmentioning

confidence: 87%

The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis

Büyükşahin

Yalçın

Emiralioğlu

et al. 2022

Pediatrics International

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“…The literature is unclear about emergence of antibiotic resistance with inhaled antibiotics. Long‐term use of inhaled antibiotics in cystic fibrosis patients increases the mean inhibitory concentration (MIC) over time but does not affect the clinical efficacy of antibiotic treatment 20–22 . Furthermore, inhaled antibiotics in cystic fibrosis have not been found to select for intrinsically resistant organisms 20–22 .…”

Section: Discussionmentioning

confidence: 99%

“…Long-term use of inhaled antibiotics in cystic fibrosis patients increases the mean inhibitory concentration (MIC) over time but does not affect the clinical efficacy of antibiotic treatment. [20][21][22] Furthermore, inhaled antibiotics in cystic fibrosis have not been found to select for intrinsically resistant organisms. [20][21][22] This differs from a review by Laska et al 23 which demonstrated that use of inhaled antibiotics increased the risk of resistant organisms in patients with bronchiectasis.…”

Section: T a B L E 4 Association Between Chronic Antibiotic Use Per Y...mentioning

confidence: 99%

“…[20][21][22] Furthermore, inhaled antibiotics in cystic fibrosis have not been found to select for intrinsically resistant organisms. [20][21][22] This differs from a review by Laska et al 23 which demonstrated that use of inhaled antibiotics increased the risk of resistant organisms in patients with bronchiectasis. There remains little literature describing emergence of antibiotic resistance with inhaled antibiotics in the pediatric tracheostomy and ventilatordependent population.…”

Section: T a B L E 4 Association Between Chronic Antibiotic Use Per Y...mentioning

confidence: 99%

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Airway multidrug‐resistant organisms in a population of tracheostomy and chronic ventilator‐dependent children at a tertiary care pediatric hospital

Havens

Rosen

Rivera-Spoljaric

2022

Pediatric Pulmonology

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Objective/Background: Children with tracheostomies are at an increased risk of bacterial respiratory tract infections. Infections caused by multidrug-resistant organisms (MDROs) are more difficult to treat and can result in severe complications. This study aimed to investigate the risk factors and sequelae of MDRO positivity in tracheostomy and chronic ventilator-dependent children. Methods: We performed a retrospective chart review of 75 tracheostomy and chronic ventilator-dependent children at St. Louis Children's Hospital. Data on demographics, respiratory cultures, hospitalizations, emergency department (ED) visits, and antibiotic usage were collected. We determined the frequency of MDRO positivity and compared the number of hospitalizations, number of ED visits, and antibiotic usage in patients with and without MDRO-positive cultures. Patient clinical variables were analyzed before and after MDRO acquisition. Results: We found 75.7% (56/74) of our participants had an MDRO-positive culture, with methicillin-resistant Staphylococcus aureus (MRSA, n = 36, 64%) and Pseudomonas aeruginosa (n = 8, 14%) being the most commonly detected organisms. Participants with a greater number of annual nonpulmonary admissions (odds ratio [OR] = 1.99, 95% confidence interval [CI] (1.21-3.29), p = 0.008], inpatient antibiotic courses [OR = 1.27, 95% CI (1.07-1.50), p = 0.006], total antibiotic courses [OR = 1.26, 95% CI (1.08-1.48), p = 0.004], and chronic antibiotic use [OR = 2.31, 95% CI (1.12-4.74), p = 0.03] were at an increased risk for MDRO positivity. Those who were MDRO-positive had more pulmonary admissions following MDRO acquisition compared those who were MDRO-negative [p = 0.005] but not more antibiotic usage or ED visits. Conclusion: Frequent antibiotic usage and hospitalizations increase the risk of MDRO acquisition in children with tracheostomies and ventilator-dependence. Further antibiotic stewardship may help prevent resistant infections in technologydependent children.

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“…Each of these cultures was treated with one of the eight combinations (see Materials and Methods) of the antipseudomonal antibiotics ciprofloxacin, colistin, and tobramycin. These antibiotics were selected because of their use either in P. aeruginosa eradication therapy or in the treatment of pulmonary exacerbations ( 11 , 12 , 43 , 44 ) as well as for their differing modes of action ( 45 – 47 ). Each of the antibiotics was applied at a sub-MIC that had small but contrasting effects on the growth of all three bacterial strains (Fig.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Antibiotic Combination Treatments on Pseudomonas aeruginosa Tolerance Evolution and Coexistence with Stenotrophomonas maltophilia

2022

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Inhaled anti-pseudomonal antibiotics for long-term therapy in cystic fibrosis

Cited by 14 publications

References 191 publications

The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis

The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis

Airway multidrug‐resistant organisms in a population of tracheostomy and chronic ventilator‐dependent children at a tertiary care pediatric hospital

The Effects of Antibiotic Combination Treatments on Pseudomonas aeruginosa Tolerance Evolution and Coexistence with Stenotrophomonas maltophilia

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