Multidrug-resistant bacteria in hospitalized patients with cystic fibrosis: a retrospective cross-sectional study

Abstract

Aims: The emergence of multidrug-resistant (MDR) bacterial pathogens has become a critical clinical challenge in cystic fibrosis (CF) patients. This study aimed to characterize MDR bacterial isolates in hospitalized CF patients experiencing pulmonary exacerbations. Methods: We defined MDR as resistance to three or more antimicrobial classes. The study included 45 acute exacerbation episodes with confirmed MDR bacterial growth among 32 CF pediatric patients hospitalized at Marmara University Pendik Training and Research Hospital. Results: Among 32 CF patients (mean age: 114.7±62.1 months; 68.8% female), we analyzed 45 exacerbation episodes. The most common clinical manifestations were increased sputum production (73.3%), cough (60%), and fever (31%). Pseudomonas aeruginosa colonization was previously documented in 55.6% of cases. Respiratory cultures revealed MDR bacteria in all patients, with P. aeruginosa (53.4%), Staphylococcus aureus (17.8%), and Acinetobacter baumannii (4.4%) being the predominant isolates. Combination antibiotic therapy was required in 82% of cases (37/45), while only 18% (8/45) received monotherapy. The mean hospitalization duration was 17.3±8.4 days, with an overall mortality rate of 6.2% (n=2). Conclusion: MDR infections in CF patients demand a multifaceted approach. Rotating antibiotic regimens and avoiding carbapenem overuse may reduce resistance. Tailored antibiotic regimens and antimicrobial stewardship programme, robust infection controls such as enhanced screening for MDR colonization and isolation protocols are needed to curb transmission, and sustained research into emerging pathogens. Our data reinforce the urgent need for CF-specific antimicrobial protocols in Turkiye and similar countries.

Keywords

• Cystic fibrosis
• multidrug-resistant
• hospitalized patients

Hastanede yatan kistik fibrozis hastalarında çoklu ilaca dirençli bakteriler: retrospektif kesitsel bir çalışma

Abstract

Amaç: Çoklu ilaca dirençli (ÇİD) bakteriyel patojenlerin ortaya çıkışı, kistik fibroz (KF) hastalarında kritik bir klinik sorun haline gelmiştir. Bu çalışma, hastanede yatan ve alevlenmeler yaşayan KF hastalarında ÇİD bakteri izolatlarını karakterize etmeyi amaçlamıştır. Yöntemler: ÇİD'yi, üç veya daha fazla antimikrobiyal sınıfa direnç olarak tanımladık. Çalışmaya, Marmara Üniversitesi Pedik Eğitim ve Araştırma Hastanesi'nde yatan 32 KF hastası arasında doğrulanmış ÇİD bakteri üremesi olan 45 akut alevlenme atağı dahil edildi. Sonuçlar: 32 KF hastası (ortalama yaş: 114,7 ± 62,1 ay; %68,8'i kadın) arasında, 45 alevlenme atağı tesbit edildi. En sık görülen klinik bulgular balgamda artış (%73,3), öksürük (%60) ve ateş (%31) idi. Pseudomonas aeruginosa kolonizasyonu vakaların %55,6'sında mevcuttu. Tüm hastaların solunum yolu kültürlerinde ÇİD bakteri üremesi vardı. P. aeruginosa (%53,4), Staphylococcus aureus (%17,8) ve Acinetobacter baumannii (%4,4) baskın izolatlardı. Vakaların %82'sinde (37/45) kombine antibiyotik tedavisi gerekirken, sadece %18'ine (8/45) monoterapi uygulandı. Ortalama hastanede kalış süresi 17,3±8,4 gündü ve genel mortalite oranı %6,2'ydi (n=2). Sonuçlar: Kistik fibrozis hastalarında ÇİD enfeksiyonların takibi ve tedavisi multidisipliner yaklaşım gerektirir. Antibiyotik rejimlerinin dönüşümlü olarak uygulanması ve karbapenem aşırı kullanımından kaçınılması direnci azaltabilir. Bulaşmayı azaltmak için hasta özelinde antibiyotik rejimleri ve antimikrobiyal yönetim programları gereklidir. ÇİD kolonizasyonu için gelişmiş tarama ve izolasyon protokolleri gibi güçlü enfeksiyon kontrolleri ve yeni ortaya çıkan patojenler üzerinde sürekli araştırmalara ihtiyaç vardır. Verilerimiz, Türkiye ve benzeri ülkelerde KF'ye özgü antimikrobiyal tedavi protokollerine ihtiyaç olduğunu desteklemektedir.

Keywords

• Kistik fibroz
• çoklu ilaç direnci
• hastanede yatan hastalar

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