Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years

• Published in: Journal of cystic fibrosis Vol. 14; no. 3; pp. 361 - 369
• Main Authors: Kidd, Timothy J, Ramsay, Kay A, Vidmar, Suzanna, Carlin, John B, Bell, Scott C, Wainwright, Claire E, Grimwood, Keith
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2015
• Subjects: Anti-Bacterial Agents - therapeutic use; Bronchoalveolar Lavage Fluid - microbiology; Child, Preschool; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - microbiology; DNA, Bacterial - genetics; Eradication; Female; Follow-Up Studies; Genotype; Genotyping; Humans; Infant; Infection; Male; Oropharynx - microbiology; Pseudomonas aeruginosa; Pseudomonas aeruginosa - genetics; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - complications; Pseudomonas Infections - drug therapy; Pseudomonas Infections - microbiology; Pulmonary/Respiratory; Retrospective Studies; New South Wales; interquartile range; odds ratio; NZ; Eradication; SA; South Australia; SD; Australasian Cystic Fibrosis BronchoAlveolar Lavage; CFU; cystic fibrosis; colony forming units; Pseudomonas aeruginosa; polymerase chain reaction; ST; CF; OR; MLST; CI; ERIC; IQR; sequence type; BAL; New Zealand; Infection; multilocus sequence typing; ACFBAL; NSW; Genotyping; confidence interval; enterobacterial repetitive intergenic consensus; bronchoalveolar lavage; PCR; standard deviation; Cystic fibrosis
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/j.jcf.2014.12.007

Abstract Background We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤ 5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources. Methods Of 168 CF children aged ≤ 5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy. Results Eighty-two (53%) subjects acquired P. aeruginosa , of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa , with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably. Conclusions CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.