期刊论文详细信息
BMC Infectious Diseases
Reduction in Pseudomonas aeruginosa sputum density during a cystic fibrosis pulmonary exacerbation does not predict clinical response
Research Article
John C Lam1  Ranjani Somayaji1  Michael D Parkins2  Harvey R Rabin2  Michael G Surette3 
[1] Department of Medicine, The University of Calgary, 3330 Hospital Dr. NW, T2N 4 N1, Calgary, Alberta, Canada;Department of Medicine, The University of Calgary, 3330 Hospital Dr. NW, T2N 4 N1, Calgary, Alberta, Canada;The Department of Microbiology, Immunology and Infectious Disease, The University of Calgary, Calgary, Canada;McMaster University, Hamilton, Ontario, Canada;The Department of Microbiology, Immunology and Infectious Disease, The University of Calgary, Calgary, Canada;
关键词: Treatment;    Biomarker;    Failure;    Outcome;    Bronchiectasis;    Cefepime;    Heterogeneity;   
DOI  :  10.1186/s12879-015-0856-5
 received in 2014-09-27, accepted in 2015-02-20,  发布年份 2015
来源: Springer
PDF
【 摘 要 】

BackgroundPulmonary exacerbations (PEx) are critical events in cystic fibrosis (CF), responsible for reduced quality of life and permanent loss of lung function. Approximately 1/4 of PEx are associated with failure to recover lung function and/or resolve symptoms. Developing tools to optimize PEx treatment is of paramount importance.MethodsWe retrospectively audited all adults infected with Pseudomonas aeruginosa, experiencing PEx necessitating parenteral antibiotic therapy from 2006–2012 from our center. Quantitative analysis of sputum at admission, twice-weekly during hospitalization, and end of therapy were compared to baseline (most recent healthy) and follow-up (after PEx) samples. Change in P. aeruginosa burden from baseline was assessed for any and all morphotypes (ALL), as well as mucoid (MUC) and non-mucoid (NON) isolates specifically. PEx were identified as failures if >90% of baseline pulmonary function was not recovered.ResultsForty-six patients meeting the above inclusion and exclusion criteria experienced 144 PEx during this time (median 3, IQR 2–6). Patients were treated for a median 14 days (IQR 13–16). No increase in ALL, MUC or NON were detected at PEx, nor was there an association between change in sputum density and magnitude of lung function decline. PEx failures were observed in 30% of events. Reductions of at least 1-log and 2 log P. aeruginosa sputum density was observed in 57% and 46% (ALL), 73% and 55% (MUC) and 58% and 46% (NON) of PEx, respectively. Factors associated with greater reduction of P. aeruginosa sputum density included choice of β-lactam antibiotic, antibiotics with in vitro predicted activity and treatment duration. PEx associated with reductions in P. aeruginosa sputum density were not associated with a reduced risk of PEx failure.ConclusionsEnhanced killing of P. aeruginosa during PEx does not predict improved clinical outcomes. Studies accounting for the polymicrobial nature of CF respiratory disease and the heterogeneity of P. aeruginosa causing chronic infection may enable the identification of a more appropriate pathogen(s) based biomarker of PEx outcomes.

【 授权许可】

Unknown   
© Lam et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

【 预 览 】
附件列表
Files Size Format View
RO202311094604278ZK.pdf 1220KB PDF download
【 参考文献 】
  • [1]
  • [2]
  • [3]
  • [4]
  • [5]
  • [6]
  • [7]
  • [8]
  • [9]
  • [10]
  • [11]
  • [12]
  • [13]
  • [14]
  • [15]
  • [16]
  • [17]
  • [18]
  • [19]
  • [20]
  • [21]
  • [22]
  • [23]
  • [24]
  • [25]
  • [26]
  • [27]
  • [28]
  • [29]
  • [30]
  • [31]
  • [32]
  • [33]
  • [34]
  • [35]
  • [36]
  • [37]
  • [38]
  • [39]
  • [40]
  • [41]
  • [42]
  • [43]
  • [44]
  • [45]
  • [46]
  • [47]
  • [48]
  • [49]
  • [50]
  • [51]
  • [52]
  • [53]
  • [54]
  • [55]
  • [56]
  • [57]
  • [58]
  • [59]
  • [60]
  文献评价指标  
  下载次数:1次 浏览次数:1次