Current Approaches to Diagnosis and Treatment of Respiratory Tract Infections in Patients with Cystic Fibrosis

Clinical Microbiology and Antimicrobial Chemotherapy. 2014; 16(2):100-110

​ Asherova I.K., Kapranov N.I.
cystic fibrosis respiratory tract infection antibiotic therapy
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2014; 16(2):100-110

Abstract

Chronic airway inflammation and infection are the main cause of mortality in patients with cystic fibrosis (CF), therefore effective antimicrobial therapy is important part of treatment of CF-lung disease. In the article, an overview on present approaches to antibiotic therapy for major pathogens in CF airway is given, experts opinion to prophylaxis of respiratory tract infections, strategy of early eradication therapy, treatment of a chronic infection and exacerbations of CF-lung disease is considered. In addition the importance of microbiological monitoring, clinical significance of antibiotic susceptibility testing, role of current microbiological diagnostic methods in routine practice is presented.

  • 1. Cystic fibrosis foundation patient registry 2009 annual data report. Bethesda, MD, USA: Cystic Fibrosis Foundation; 2010.
  • 2. Красовский С.А., Черняк А.В., Никонова В.С. и др. Выживаемость больных муковисцидозом в московском регионе за период 2003–2012гг. Сборник тезисов XI национального конгресса «Муковисцидоз детей и взрослых. Взгляд в будущее» 2013, с. 53.
  • 3. LiPuma J.J. Burkholderia and emerging pathogens in cystic fibrosis. Semin Respir Crit Care Med 2003; 24:681-92.
  • 4. Lee T.W., Brownlee K.G., Conway S.P., Denton M., Littlewood J.M. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros 2003; 2:29-34.
  • 5. Proesmans M., Balinska-Miskiewicz W., Dupont L., et al. Evaluating the “Leeds criteria” for Pseudomonas aeruginosa infection in a cystic fibrosis centre. Eur Respir J 2006; 27:937-43.
  • 6. Döring G., Meisner C., Stern M. A double-blind randomized placebo-controlled phase III study of a Pseudomonas aeruginosa flagella vaccine in cystic fibrosis patients. PNAS 2007; 104:11020-5.
  • 7. Wiesemann H.G., Steinkamp G., Ratjen F., et al. Placebocontrolled, double-blind, randomized study of aerolized tobramycin for early treatment of Pseudomonas aeruginosa infection in cystic fibrosis. Pediatr Pulmonol 1998; 25:88-92.
  • 8. Gibson R.L., Emerson J., McNamara S., et al. Significant microbiological effect of inhaled tobramycin in young children with cystic fibrosis. Am J Respir Crit Care Med 2003; 167:841e9.
  • 9. Taccetti G., Campana S., Festini F., Mascherini M., Döring G. Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients. Eur Respir J 2005; 26:1-4.
  • 10. Treggiari M.M., Retsch-Bogart G., Mayer-Hamblett N., et al. Comparative efficacy and safety of 4 randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis. Arch Pediatr Adolesc Med 2011; 165:847-56.
  • 11. Ratjen F., Döring G., Nikolaizik W.H. Effect of inhaled tobramycin on early Pseudomonas aeruginosa colonisation in patients with cystic fibrosis. Lancet 2001; 358:983-4.
  • 12. Gibson R.L., Emerson J., Mayer-Hamblett N., et al. Duration of treatment effect after tobramycin solution for inhalation in young children with cystic fibrosis. Pediatr Pulmonol 2007; 42:610-23.
  • 13. Taccetti G., Bianchini E., Cariani L., Buzzetti R., Costantini D., Trevisan F. Early antibiotic treatment for Pseudomonas aeruginosa eradication in patients with cystic fibrosis: a randomised multicentre study comparing two different protocols. Thorax 2012; 67:853-9.
  • 14. Proesmans M. Comparison of two treatment regimens for eradication of P aeruginosa infection in children with cystic fibrosis. J Cyst Fibros http://www.ncbi.nlm.nih. gov/pubmed/22762867.
  • 15. Noah T.L., Ivins S.S., Abode K.A., et al. Inhaled versus systemic antibiotics and airway inflammation in children with cystic fibrosis and Pseudomonas. Pediatr Pulmonol 2010; 45:281-90.
  • 16. Rosenfeld M., Gibson R., McNamara S., et al. Serum and lower respiratory tract drug concentrations produced by tobramycin for inhalation in young children with cystic fibrosis. J Pediatr 2001; 139:572-7.
  • 17. Hansen C.R., Pressler T., Høiby N. Early aggressive eradication therapy for intermittent Pseudomonas aeruginosa airway infection in cystic fibrosis patients: 15 years experience. J Cyst Fibros 2008; 7:523-30.
  • 18. Treggiari M.M., Rosenfeld M., Retsch-Bogart G., Gibson R., Ramsey B. Approach to eradication of initial Pseudomonas aeruginosa infection in children with cystic fibrosis. Pediatr Pulmonol 2007; 42:751-6.
  • 19. Muhlebach M.S., Miller M.B., Moore C., Wedd J.P., Drake A.F., Leigh M.W. Are lower airway or throat cultures predictive of sinus bacteriology in cystic fibrosis? Pediatr Pulmonol 2006; 41:445-1.
  • 20. Döring G., Flume P., Heijerman H., Elborn J.S. Treatment of lung infection in patients with cystic fibrosis: Current and future strategies. J Cyst Fibros 2012; 11:461-79.
  • 21. Hansen S.K., Rau M.H., Johansen H.K., et al. Evolution and diversification of Pseudomonas aeruginosa in the paranasal sinuses of cystic fibrosis children have implications for chronic lung infection. ISME J 2012; 6(1):31- 45.
  • 22. Johansen H.K., Aanaes K., Pressler T., et al. Colonization and infection of the paranasal sinuses in cystic fibrosis patients is accompanied by a reduced PMN response. J Cyst Fibros 2012; 11:525-31.
  • 23. Ramsey B.W., Pepe M.S., Quan JM, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. N Engl J Med 1999; 340:23-30.
  • 24. ChuchalinA., CsiszérE., GyurkovicsK., et al.Formulation of aerosolized tobramycin (Bramitob) in the treatment of patients with cystic fibrosis and Pseudomonas aeruginosa infection: a double-blind, placebo-controlled, multicenter study. Paediatr Drugs 2007; 9(Suppl. 1):21-31.
  • 25. Konstan M.W., Flume P.A., Kappler M., et al. Safety, efficacy and convenience of tobramycin inhalation powder in cystic fibrosis patients: the EAGER trial. J Cyst Fibros 2011; 10:54–61.
  • 26. Konstan M.W., Geller D.E., Miniö P., Brockhaus F., Zhang J., Angyalosi G.. Tobramycin inhalation powder for P. aeruginosa infection in cystic fibrosis: the EVOLVE trial. Pediatr Pulmonol 2011; 46:230-8.
  • 27. Assael B.M., Pressler T., Bilton D., et al. Inhaled aztreonam lysine vs. inhaled tobramycin in cystic fibrosis: a comparative efficacy trial. J Cyst Fibros 2013; 12: 130-40.
  • 28. Schuster A., Haliburn C., Döring G., et al. Safety, efficacy and convenience of colistimethate sodium dry powder for inhalation (Colobreathe® DPI) in cystic fibrosis patients: a randomised study. Thorax 2013; 68(4):344-50.
  • 29. Sanders D.B., Bittner R.C., Rosenfeld M., Hoffman L.R., Redding G.J., Goss C.H. Failure to recover to baseline pulmonary function after cystic fibrosis pulmonary exacerbation. Am J Respir Crit Care Med 2010; 182:627-32.
  • 30. Aaron S.D., Vandemheen K.L., Ferris W., et al. Combination antibiotic susceptibility testing to treat exacerbations of cystic fibrosis associated with multiresistant bacteria: a randomised, double-blind, controlled clinical trial. Lancet 2005; 366:463-71.
  • 31. Moskowitz S.M., Emerson J.C., McNamara S., et al. Randomized trial of biofilm testing to select antibiotics for cystic fibrosis airway infection. Pediatr Pulmonol 2010; 6:184-92.
  • 32. Parkins M.D., Rendall J.C., Elborn J.S. Incidence and risk factors for pulmonary exacerbation treatment failures in cystic fibrosis patients chronically infected with Pseudomonas aeruginosa. Chest 2012; 141(2):485-93.
  • 33. Döring G., Hoiby N. Early intervention and prevention of lung disease in cystic fibrosis: a European consensus. J Cyst Fibros 2004; 3:67-91.
  • 34. RatjenF., Walter H., HaugM., MeisnerC., GrasemannH., Döring G. Diagnostic value of serum antibodies in early Pseudomonas aeruginosa infection in cystic fibrosis patients. Pediatr Pulmonol 2007;42:249-55.
  • 35. Regelmann W.E., Elliott G.R., Warwick W.J., Clawson C.C. Reduction of sputum Pseudomonas aeruginosa density by antibiotics improves lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone. Am Rev Respir Dis 1990; 141:914- 21.
  • 36. Tunney M.M., Field T.R., Moriarty T.F., et al. Detection of anaerobic bacteria in high numbers in sputum from patients with cystic fibrosis. Am J Respir Crit Care Med 2008; 177:995-1001.
  • 37. Yang L., Jelsbak L., Marvig R.L., et al. Evolutionary dynamics of bacteria in a human host environment. PNAS 2011; 108:7481-6.
  • 38. Blainey P.C., Milla C.E., Cornfield D.N., Quake S.R. Quantitative analysis of the human airway microbial ecology reveals a pervasive signature for cystic fibrosis. Sci Transl Med 2012; 4:153ra130.
  • 39. Rogers G.B., Marsh P., Stressmann A.F., et al. The exclusion of dead bacterial cells is essential for accurate molecular analysis of clinical samples. Clin Microbiol Infect 2010; 16:1656-8.
  • 40. Tunney M.M., Field T.R., Moriarty T.F., et al. Detection of anaerobic bacteria in high numbers in sputum from patients with cystic fibrosis. Am J Respir Crit Care Med 2008; 177:995-1001.
  • 41. Fibrosis Trust Cystic. Antibiotic Treatment for Cystic Fibrosis — Report of the UK Cystic Fibrosis Antibiotic Working Group. 3rd ed.
  • 42. Smyth A., Walters S.. In: Prophylactic antibiotics for cystic fibrosis. The Cochrane Library. 3:Oxford: Update Software; 2001.
  • 43. Flume P.A., O’Sullivan B.P., Robinson K.A., et al. Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. Am J Respir Crit Care Med 2007; 176:957-69.
  • 44. Stutman H.R., Lieberman J.M., Nussbaum E., Marks M.I. Antibiotic prophylaxis in infants and young children with cystic fibrosis: a randomized controlled trial. J Pediatr 2002; 140:299-305.
  • 45. Vanderhelst E., De Meirleir L., Verbanck S., Pierard D., VinckenW., Malfroot A. Prevalence and impact on FEV1 decline of chronic methicillin-resistant Staphylococcus aureus (MRSA) infection in patients with cystic fibrosis. A single-center, case–control study of 165 patients. J Cyst Fibros 2012; 11:2-7.
  • 46. Doe S.J., McSorley A., Isalska B., Kearns A.M., BrightThomas R., Brennan A.L., Webb A.K., Jones A.M. Patient segregation and aggressive antibiotic eradication therapy can control methicillin-resistant Staphylococcus aureus at large cystic fibrosis centres. J Cyst Fibros 2010; 9:104-9.
  • 47. Macfarlane M., Leavy A., McCaughan J. et al. Successful decolonisation of methicillinresistant Staphylococcus aureus in paediatric patients with cystic fibrosis (CF) using a three-step protocol. J Hosp Infect 2007; 65:231-6.
  • 48. Solis A., Brown D., Hughes J., et al. Methicillin-resistant Staphylococcus aureus in children with cystic fibrosis: An eradication protocol. Pediatr Pulmonol 2003; 36:189-95.
  • 49. Staphylococcus aureus and methicillin resistant Staphylococcus aureus. The Leeds Method of Management. 2008. Regional Adult and Paediatric Cystic Fibrosis Units. St James’s University Hospital. UK.
  • 50. De Vrankrijker A.M.M., Wolfs T.F.W., Van der Ent C.K. Challenging and emerging pathogens in cystic fibrosis. Paediatr Respir Rev 2010; 11:246-54.
  • 51. Waters V., Yau Y., Prasad S., et al. Stenotrophomonas maltophilia in cystic fibrosis: serologic response and effect on lung disease. Am J Respir Crit Care Med 2011; 183:635-40.
  • 52. Hansen C.R., Pressler T., Nielsen K.G. et al. Inflammation in Achromobacter хylosoxidans infected cystic fibrosis patients. J Cyst Fibros 2010; 9:51-58.
  • 53. Ian M., Balfour-Lynn, Elborn J.S. Respiratory disease: infection. Cystic Fibrosis, third edition, ed. M.Hodson, D.Geddes, A.Bush., London. 2007; рр137-59.
  • 54. LiPuma J. The changing microbial epidemiology in CF. Clin Microbiol Rev 2010; 23:299-323.
  • 55. LiPuma J.J. Burkholderia cepacia epidemiology and pathogenesis: implications for infection control. Curr Opin Pulm Med 1998; 4:337-41.
  • 56. Kalish L.A., Waltz D.A., Dovey M. et al. Impact of Burkholderia dolosa on lung function and survival in cystic fibrosis. Am J Respir Crit Care Med 2006; 173:421-5.
  • 57. Чернуха М.Ю. Реализация патогенности бактерий Burkholderia cepacia при разных формах инфекций. Автореф дисс доктора мед наук. М. 2008. 42 с.
  • 58. Amelina E., Cherniak A., Krasovsky S. Burkholderia cepacia infection in adult cystic fibrosis patients: its impact on lung function and survival. Abstrac 20th ERS Annual Congress. Barcelona, Spain, September 18-22, 2010. Eur Respir J 2010; 36 (suppl.54):885s.
  • 59. McMenamin J.D., Zaccone T.M., Coenye T., Vandamme P., LiPuma J.J. Misidentification of Burkholderia cepacia in U.S. cystic fibrosis treatment centers: an analysis of 1051 recent sputum isolates. Chest 2000; 117:1661-5.
  • 60. Чернуха М.Ю., Шагинян И.Л., Капранов Н.И., Алексеева Г.В., Каширская Н.Ю., Аветисян Л.Р., Семыкин С.Ю., Данилина Г.А., Поликарпова С.В., Пивкиназ Н.В. Персистенция Burkholderia cepacia у больных муковисцидозом. Микробиология, эпидемиология и иммунобиология 2012; (4):93-8.
  • 61. Cystic Fibrosis in children and adults. The Leeds Method of Management 2008, St James’s University Hospital, UK.
  • 62. Middleton P.G., Kidd T.J., Williams B. Combination aerosol therapy to treat Burkholderia cepacia complex. Eur Respir J 2005; 26:305-8.
  • 63. Fauroux B., Delaisi B., Clement A., et al. Mycobacterial lung disease in cystic fibrosis: a prospective study. Pediatr Infect Dis J 1997; 16:354-8.
  • 64. Griffith D.E., Aksamit T., Brown-Elliott B.A., et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416.
  • 65. Esther C.R., Henry M.M., Molina P.L., Leigh M.W. Nontuberculous mycobacterial infection in young children with cystic fibrosis. Pediatr Pulmonol 2005; 40:39- 44.
  • 66. Renna M., Schaffner C., Brown K., et al. Azithromycin blocks autophagy and may predispose cystic fibrosis patients to mycobacterial infection. J Clin Invest 2011; 121:3554-63.
  • 67. Fleet J., Guha K., Piper S., Banya W., Bilton D., Hodson M.E. A retrospective analysis of the impact of azithromycin maintenance therapy on adults attending a UK cystic fibrosis clinic. J Cyst Fibros 2013; 12: 49-53.
  • 68. Cox M.J., Allgaier M., Taylor B., et al. Airway microbiota and pathogen abundance in age-stratified cystic fibrosis patients. PLoS One 2010; 5:e11044.
  • 69. Klepac-Ceraj V., Lemon K.P., Martin T.R., et al. Relationship between cystic fibrosis respiratory tract bacterial communities and age, genotype, antibiotics and Pseudomonas aeruginosa. Environ Microbiol 2010; 12:1293–1303.
  • 70. Ulrich M., Beer I., Braitmaier P., et al. Relative contribution of Prevotella intermedia and Pseudomonas aeruginosa to lung pathology in airways of cystic fibrosis patients. Thorax 2010; 65:978-84.
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