Microbial Epidemiology of the Cystic Fibrosis Airways: Past, Present, and Future

Thornton, Christina S.; Parkins, Michael D.

doi:10.1055/s-0042-1758732

Cited by 23 publications

(24 citation statements)

References 232 publications

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“…The classic understanding of the pathogen landscape of clinical worsening of cystic fibrosis is widening with the detection of increasing number of NFGNB [28 ▪▪ ]. Studies using microbiome analysis report the presence of additional, uncommon bacteria such as Stenotrophomonas spp.…”

Section: Text Of Reviewmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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Purpose of review This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species. Recent findings The reported frequency of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa is increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is, A. baumannii and P. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such as Stenotrophomonas maltophilia, Burkholderia spp., Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., Alcaligenes spp., Sphingomonas spp., Shewanella spp. and Ralstonia spp., among others. Summary The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.

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Section: Text Of Reviewmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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“…The major cause of mortality in people with CF (pwCF) is progressive lung disease characterised by bacterial, fungal and viral infections, the accumulation of viscous mucus, airway inflammation, structural damage and recurrent pulmonary exacerbations 3–5. Dysfunctional mucociliary clearance in the CF airway allows pathogens to colonise the respiratory tract, where they can cause chronic airway infections and persistent inflammation, resulting in structural damage (eg, bronchiectasis and airway destruction) and deteriorating respiratory function 6 7…”

Section: Introductionmentioning

confidence: 99%

“…Pseudomonas aeruginosa , a gram-negative bacterium, is one of the most prevalent and important pathogens in adult CF lungs,6 with the prevalence of infection rising steeply in the teenage years (figure 1). 8 9 The prevalence of P. aeruginosa infection increases with age,10 affecting 5%–20% of children with CF aged ≤2 years11 and approximately 40%–50% of adults with CF aged approximately 30–45 years (figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…8 9 The prevalence of P. aeruginosa infection increases with age,10 affecting 5%–20% of children with CF aged ≤2 years11 and approximately 40%–50% of adults with CF aged approximately 30–45 years (figure 1). 8 9 Acquisition occurs from environmental sources or via transmission from other pwCF4 6 12; most first infections are caused by unique, non-clonal strains, whereas shared strains are disproportionally observed in older pwCF 10 . P. aeruginosa evades the immune system via several adaptive behaviours, including downregulation of flagella expression and production of exopolysaccharides, which facilitate biofilm formation 4.…”

Section: Introductionmentioning

confidence: 99%

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Considerations for the use of inhaled antibiotics forPseudomonas aeruginosain people with cystic fibrosis receiving CFTR modulator therapy

Burgel,

Ballmann,

Drevinek

et al. 2024

BMJ Open Resp Res

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The major cause of mortality in people with cystic fibrosis (pwCF) is progressive lung disease characterised by acute and chronic infections, the accumulation of mucus, airway inflammation, structural damage and pulmonary exacerbations. The prevalence ofPseudomonas aeruginosarises rapidly in the teenage years, and this organism is the most common cause of chronic lung infection in adults with cystic fibrosis (CF). It is associated with an accelerated decline in lung function and premature death. NewP. aeruginosainfections are treated with antibiotics to eradicate the organism, while chronic infections require long-term inhaled antibiotic therapy. The prevalence ofP. aeruginosainfections has decreased in CF registries since the introduction of CF transmembrane conductance regulator modulators (CFTRm), but clinical observations suggest that chronicP. aeruginosainfections usually persist in patients receiving CFTRm. This indicates that pwCF may still need inhaled antibiotics in the CFTRm era to maintain long-term control ofP. aeruginosainfections. Here, we provide an overview of the changing perceptions ofP. aeruginosainfection management, including considerations on detection and treatment, the therapy burden associated with inhaled antibiotics and the potential effects of CFTRm on the lung microbiome. We conclude that updated guidance is required on the diagnosis and management ofP. aeruginosainfection. In particular, we highlight a need for prospective studies to evaluate the consequences of stopping inhaled antibiotic therapy in pwCF who have chronicP. aeruginosainfection and are receiving CFTRm. This will help inform new guidelines on the use of antibiotics alongside CFTRm.

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“…Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen and one of the major causes of nosocomial infections, particularly affecting intensive care units (ICU) and immunocompromised patients, with a very high morbidity and mortality rate (Botelho et al, 2019;Thornton and Parkins, 2023). In addition, P. aeruginosa is the most frequent chronic…”

Section: Introductionmentioning

confidence: 99%

Whole-genome sequencing reveals high-risk clones of Pseudomonas aeruginosa in Guangdong, China

Zhao

Chen

et al. 2023

Front. Microbiol.

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The ever-increasing prevalence of infections produced by multidrug-resistant or extensively drug-resistant Pseudomonas aeruginosa is commonly linked to a limited number of aptly-named epidemical ‘high-risk clones’ that are widespread among and within hospitals worldwide. The emergence of new potential high-risk clone strains in hospitals highlights the need to better and further understand the underlying genetic mechanisms for their emergence and success. P. aeruginosa related high-risk clones have been sporadically found in China, their genome sequences have rarely been described. Therefore, the large-scale sequencing of multidrug-resistance high-risk clone strains will help us to understand the emergence and transmission of antibiotic resistances in P. aeruginosa high-risk clones. In this study, 212 P. aeruginosa strains were isolated from 2 tertiary hospitals within 3 years (2018–2020) in Guangdong Province, China. Whole-genome sequencing, multi-locus sequence typing (MLST) and antimicrobial susceptibility testing were applied to analyze the genomic epidemiology of P. aeruginosa in this region. We found that up to 130 (61.32%) of the isolates were shown to be multidrug resistant, and 196 (92.45%) isolates were Carbapenem-Resistant Pseudomonas aeruginosa. MLST analysis demonstrated high diversity of sequence types, and 18 reported international high-risk clones were identified. Furthermore, we discovered the co-presence of exoU and exoS genes in 5 collected strains. This study enhances insight into the regional research of molecular epidemiology and antimicrobial resistance of P. aeruginosa in China. The high diversity of clone types and regional genome characteristics can serve as a theoretical reference for public health policies and help guide measures for the prevention and control of P. aeruginosa resistance.

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Microbial Epidemiology of the Cystic Fibrosis Airways: Past, Present, and Future

Cited by 23 publications

References 232 publications

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Considerations for the use of inhaled antibiotics forPseudomonas aeruginosain people with cystic fibrosis receiving CFTR modulator therapy

Whole-genome sequencing reveals high-risk clones of Pseudomonas aeruginosa in Guangdong, China

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