Changes in Antibiotic Resistance of Children with Cystic Fibrosis and Impact on Clinical Outcomes

Abstract

Aim: Antibiotics have an important role in the treatment of cystic fibrosis (CF) lung disease. Antibiotic resistance, especially multidrug resistance (MDR), increases in CF. This study aimed to determine whether there is a change in antibiotic resistance of pathogens isolated from the respiratory tract specimens of CF patients and to evaluate the relationship between the antibiotic resistance and patients’ clinical status and pulmonary function. Material and Methods: Thirty-nine CF patients with identified microorganisms in respiratory tract specimens from August 2010 through December 2016 were included in the study. 333 respiratory cultures taken from 39 CF patients were analyzed retrospectively. Results: Methicillin-sensitive S. aureus (MSSA) was isolated from 122 (31.0%) cultures, P. aeruginosa from 97 (24.7%), and methicillin-resistant S. aureus (MRSA) from 22 (5.6%). The prevalence of MSSA (p=0.020) and MRSA (p=0.010) increased from 2010 to 2016, while the prevalence of P. aeruginosa and other microorganisms did not increase. MDR-S. aureus and MDR-P. aeruginosa prevalence did not change, but MRSA prevalence increased over the years (p=0.001). There was a significant relation between the antibiotic resistance and acute pulmonary exacerbations, pulmonary examination findings, loss in weight and height percentile. As the antibiotic resistance increased, FEV1, FVC, FEV1/FVC, PEF, and FEF25-75 were significantly decreased. The use of long-term azithromycin or inhaled antibiotics was not associated with antibiotic resistance. Conclusion: In CF patients, resistance to antibiotics increased over the years. It is important to obtain respiratory tract cultures regularly and initiate rational antibiotic treatment based on culture results.

Keywords

• Cystic fibrosis
• multi-drug resistance
• respiratory cultures
• antibiotic resistance

Kistik Fibrozisli Çocuklarda Antibiyotik Direncindeki Değişimler ve Klinik Sonuçlar Üzerindeki Etkisi

Abstract

Amaç: Antibiyotikler, kistik fibrozis (KF) akciğer hastalığının tedavisinde önemli bir role sahiptir. KF'de antibiyotik direnci, özellikle çoklu ilaç direnci (ÇİD) artmaktadır. Bu çalışmanın amacı, KF hastalarının solunum yolu örneklerinden izole edilen mikroorganizmaların antibiyotik direncinde bir değişiklik olup olmadığını belirlemek ve antibiyotik direnci ile hastaların klinik durumu ve akciğer fonksiyonları arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Ağustos 2010 ile Aralık 2016 tarihleri arasında solunum yolu örneklerinde mikroorganizma tespit edilen 39 KF hastası çalışmaya dahil edildi. 39 KF hastasından alınan 333 solunum kültürü geriye dönük olarak analiz edildi. Bulgular: Metisiline duyarlı S. aureus (MSSA) 122 (%31,0), P. aeruginosa 97 (%24,7) ve metisiline dirençli S. aureus (MRSA) 22 (%5,6) kültürden izole edildi. MSSA (p=0,020) ve MRSA (p=0,010) prevalansı 2010'dan 2016'ya artarken, P. aeruginosa ve diğer mikroorganizmaların prevalansı artmamıştı. ÇİD-S. aureus ve ÇİD-P. aeruginosa prevalansı değişmemiş, ancak MRSA prevalansı yıllar içinde artmıştı (p=0,001). Antibiyotik direnci ile akut pulmoner alevlenme, akciğerde dinleme bulgularının varlığı, kilo ve boy persentil kaybı arasında anlamlı ilişki saptandı. Antibiyotik direnci arttıkça FEV1, FVC, FEV1/FVC, PEF, FEF25-75 anlamlı olarak azalmıştı. Uzun süreli azitromisin veya inhale antibiyotik kullanımı ile antibiyotik direnci arasında ilişkili bulunmadı. Sonuç: KF hastalarında antibiyotiklere karşı direnç yıllar içinde artmıştır. Düzenli olarak solunum yolu kültürlerinin alınması ve kültür sonuçlarına göre akılcı antibiyotik tedavisinin planlanması önemlidir.

Keywords

• Kistik fibrozis
• çoklu ilaç direnci
• solunum kültürleri
• antibiyotik direnci

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