Clinical and microbiological impact of inhaled tobramycin treatment on cystic fibrosis patients with Pseudomonas aeruginosa

Abstract

Clinical and Microbiological Impact of Inhaled Tobramycin Treatment on Cystic Fibrosis Patients with Pseudomonas aeruginosa

Francesca Dickhaus¹, Mutasim Abu Hasan², Elizabeth Tremblay³, Kenneth Klinker⁴, Kenneth Rand^5,6

Stacy G. Beal⁵

¹University of Florida College of Medicine, Gainesville, Florida, USA

²University of Florida College of Medicine, Department of Pediatrics, Pediatric Pulmonary and Allergy Division, Gainesville, Florida, USA

³UF Health Shands Hospital, Department of Infection Control, Gainesville, Florida, USA

⁴UF Health Shands Hospital, Department of Pharmacy Practice, Gainesville, Florida, USA

⁵University of Florida College of Medicine, Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, Florida, USA

⁶University of Florida College of Medicine, Department of Internal Medicine, Division of Infectious Diseases and Global Medicine, Gainesville, Florida, USA

 

ABSTRACT

Objective: Patients’ with cystic fibrosis respiratory systems become colonized with pathogens as early as the first year of life.  Some organisms are associated with a decline in pulmonary function and shortened survival, such as a mucoid strain of Pseudomonas aeruginosa (PA).

Methods: We conducted a four year retrospective chart review study examining 158 pediatric and adult cystic fibrosis patients treated at an academic, tertiary care institution to compare patients treated by different antimicrobial regimens.

Results: A higher proportion of mucoid PA study patients received alternate-monthly tobramycin therapy (83.3%), compared to those with non-mucoid PA (62.5%); although a large percentage of patients who had never had a mucoid PA infection were also receiving alternate-monthly tobramycin. Patients who had a mucoid PA infection had more hospitalizations and for longer periods of time than patients who had a non-mucoid PA infection; both mucoid and non-mucoid PA patients were hospitalized more often than patients who had never had a PA infection. We additionally found patients with mucoid PA infections to have strains that were either resistant or had intermediate resistance to tobramycin. Similar trends in resistance were not seen in patients who only received intermittent treatments with tobramycin.

Conclusions Our findings on increased rates of infection with both Aspergillus (in the alternate-monthly inhaled tobramycin group) and NTM (in the overall patient population) comparative to international averages were also interesting, and open the doors to future research regarding CF patients with these infections. J Microbiol Infect Dis 2017; 7(4):178-185

Keywords:Cystic fibrosis, Pseudomonas, Tobramycin

Keywords

• HIV,HCV,Genotype,Co-infection,Viral load

Kaynakça

1. 1. Strausbaugh SD, Davis PB. Cystic fibrosis: a review of epidemiology and pathobiology. Clin Chest Med 2007, 28:279-288. 2. De Boeck K, Zolin A, Cuppens H, Olesen HV, Viviani L. The relative frequency of CFTR mutation classes in European patients with cystic fibrosis. J Cyst Fibros 2014, 13:403-409. 3. Troxler RB, Hoover WC, Britton LJ, Gerwin AM, Rowe SM. Clearance of initial mucoid Pseudomonas aeruginosa in patients with cystic fibrosis. Pediatr Pulmonol 2012, 47:1113-1122. 4. Hauser AR, Jain M, Bar-Meir M, McColley SA. Clinical significance of microbial infection and adaptation in cystic fibrosis. Clin Microbiol Rev 2011, 24:29-70. 5. Vazquez-Espinosa E, Giron RM, Gomez-Punter RM, et al. Long-term safety and efficacy of tobramycin in the management of cystic fibrosis. Ther Clin Risk Manag 2015, 11:407-415. 6. Lipuma JJ. The changing microbial epidemiology in cystic fibrosis. Clin Microbiol Rev 2010, 23:299-323. 7. Pritt B, O'Brien L, Winn W. Mucoid Pseudomonas in cystic fibrosis. Am J Clin Pathol 2007, 128:32-34. 8. Barclay ML, Begg EJ, Chambers ST, Thornley PE, Pattemore PK, Grimwood K. Adaptive resistance to tobramycin in Pseudomonas aeruginosa lung infection in cystic fibrosis. J Antimicrob Chemother 1996, 37:1155-1164. 9. Lahiri T, Hempstead SE, Brady C, et al. Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis. Pediatrics 2016, 137. 10. Gozdzik J, Cofta S, Piorunek T, Batura-Gabryel H, Kosicki J. Relationship between nutritional status and pulmonary function in adult cystic fibrosis patients. J Physiol Pharmacol 2008, 59 Suppl 6:253-260. 11. Bryant JM, Grogono DM, Greaves D, et al. Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystic fibrosis: a retrospective cohort study. Lancet 2013, 381:1551-1560. 12. Qvist T, Pressler T, Hoiby N, Katzenstein TL. Shifting paradigms of nontuberculous mycobacteria in cystic fibrosis. In: Respir Res; 2014:41. vol 15.]