Reduction in prevalence of chronic Pseudomonas aeruginosa infection at a regional pediatric cystic fibrosis center

Abstract

Various management strategies were introduced at the Leeds Regional Cystic Fibrosis (CF) Unit in an attempt to reduce the prevalence of chronic Pseudomonas aeruginosa respiratory infection, previously thought to be inevitable in most children with CF. These included neonatal screening (1975), regular microbiological monitoring (1975), early antibiotic treatment of first isolations of P. aeruginosa (1985), intensive intravenous antibiotic treatment where nebulized antibiotics failed to eradicate P. aeruginosa (1988), and separate clinics for patients chronically infected with P. aeruginosa and uninfected patients (1991). The aim of this study was to assess the impact of these interventions. All 232 patients receiving full-time care at the Leeds Paediatric CF Centre during the period January 1990-December 2000 were categorized into four groups: never grown P. aeruginosa; free of P. aeruginosa for at least 1 year; intermittent grower of P. aeruginosa with </=50% of months with samples positive for P. aeruginosa over the previous 12 months; and chronic P. aeruginosa infection with >50% of months with samples positive for P. aeruginosa over the previous 12 months. The yearly prevalence of patients having chronic P. aeruginosa infection fell significantly during the study, from 24.5% in 1990 to 18.1% in 2000 (P < 0.05), despite an increase in mean age of patients from 7.73 to 9.42 years. The number of patients aged less than 11 years who had chronic P. aeruginosa infection fell from 23.8% in January 1990 to only 4.3% by December 2000. The annual incidence and mean age of first acquisition of P. aeruginosa did not alter significantly. In conclusion, antipseudomonal management strategies were associated with both reduced prevalence, and an increase in the mean age of onset of chronic P. aeruginosa infection.

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

“…An aggressive approach based on repeated BAL has not proven useful (Wainwright et al, 2011). The 20% failure rate of the more commonly used approach (Frederiksen et al, 1997;Lee et al, 2004;Tacetti et al, 2004) underlines the necessity to develop other intervention modalities.…”

“…Preventing this colonisation is considered the most important challenge for the CF clinician, as it frequently determines the patient's future quality of life and long-term survival (CF Trust 2002;Koch, 2002). The current approach relies on two strategies (Frederiksen et al, 1999): i) paying attention to segregate patients on bacteriological grounds in order to limit the risk of cross-infections (West et al, 2002;Conway et al, 2008), ii) early antibiotic treatment at the time of the first PA colonisation (Littlewood et al, 1985;Valerius et al, 1991;Frederiksen et al, 1997;Lee et al, 2004). A number of regimens have been evaluated (Stuart et al, 2010) but there is no consensus about the best combination, dosage, or length of treatment course.…”

Newborn Screening for Cystic Fibrosis: Evaluation of Benefits and Risks and Recommendations for State Newborn Screening Programs—

“…One RCT identified an apparent risk of elevated P. aeruginosa isolation after 4 years of continual prophylaxis (115). Certain U.K. centers that use antistaphyloccocal prophylaxis with aggressive treatment regimens to eradicate P. aeruginosa infections report promising results in terms of improved outcomes (42,43).…”

“…Persons with CF receive antibiotic treatment (oral, inhaled, or intravenous) for pulmonary exacerbations, characterized by increased cough and sputum production. Regular microbiologic monitoring and aggressive antibiotic treatment of infections have been demonstrated to reduce the number of children who experience chronic P. aeruginosa infections (43). Physiotherapy and inhalation of nebulized mucolytics are also common components of treatment regimens.…”

Can transmissible strains ofPseudomonas aeruginosabe successfully eradicated?: Table 1–

“…The UK Cystic Fibrosis Trust consensus guidelines suggest the use of oral ciprofloxacin and nebulised colistin when P. aeruginosa is first isolated [7]. Paediatric CF centres that have introduced measures to prevent crossinfection and adopted a policy of proactive screening and aggressive treatment of early P. aeruginosa infection have reported significant reductions in age-dependent prevalence of P. aeruginosa infection [8]. Successful eradication has also been shown to be associated with a reduced deterioration in lung function [6].…”