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95. Bacterial pathogenes cultures in the CF children — A longitudinal study on 7 years
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Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84
Russian CF Centre. L. Shabalova, S. Polikarpova, O. Simonova, I. Osipova. Department of Cystic Fibrosis, Institute of Clinical Genetics, RAMS, Moscow, Russia. In 1998 we analysed the bacterial flora of sputum of 193 CF patients under 15 years. The sputum was collected by the cough or by deep throat swabs. The purpose of the study is the observation on the change of the composition of bacterial pathogens in CF patients of our centre and its sensitivity to antibiotics. Pseudomonas aeruginosa (PA) remains the most important pathogen in CF patients. Up to 75% of patients in the age 5 mth–15 y carry PA in the sputum. 56% of them have chronic PA lung infection. From 773 bacterial strains PA form 30%, St. aureus-29%, B. cepacia and Stenotrophomonas maltophilia – 2.5 and 2.5%%. The sensitivity (sensitive and intermediate) of PA sm. and muc. strains to amikacin, gentamicin, tobramycin, ciprofloxacin, ceftazidim, carbenicillin, colimycin – 88–75; 81–73; 95–88; 97–93; 59–60; 42–36; 96–96%% accordingly. The sensitivity of bacterial association of P.A. sm. 1 St. aureus and P.A. sm. 1 P.A. muc. 1 St. aureus to ciprofloxacin, gentamicin, amikacin and ceftazidim is 65–59; 62–52; 36–22; 0–0%% accordingly. Bukhoderia cepacia and Stenotrophomonas maltophilia sensitive (sensitive 1 intermediate) to amikacin, gentamicin, tobramycin, ciprofloxacin, ceftazidim, carbenicillin, colimycin in 16–22; 11–10; 22–11; 68–69; 53–34; 16–50; 43–44%% accordingly.
95. Bacterial pathogenes cultures in the CF children – A longitudinal study on 7 years. I. Popa 1 , L. Pop 1 , Z. Popa 2 . 1 Clinic II Paediatrics, University of Medicine and Pharmacy, Timisoara, 2 CF Centre Timisoara, Romania. A 7 years study on the pathogene germs in the CF children has been done. We assessed: the occurrence of one germ in the culture, bacterial association within the same culture, the presence of different germs in the same patient. From a lot of 32 CF patients, with their age rated between 0–17 years (average age 13.8 years), 62.5% showed positive repeated cultures. At a range of 4–6 cultures / year, we identified the following bacteria: P. aeruginosa (53.29%), S. aureus (35.54%), Klebsiella pneumoniae (11.17%), E. Coli (8.6%). Among the Pseudomonas species, the mucous ones represented 45%. 22% of the patients constantly had mixed infection. Among the patients with a single infection, 45% showed P. aeruginosa in the cultures, 37% S. aureus, 11% Klebsiella and 7% E. Coli. Conclusions: P. aeruginosa is the most frequent bacterium in the respiratory infection of the CF children; the mucous and non-mucous species have similar percentages; a relatively high incidence of other Gram-negative germs; in the mixed infection cases, the germs association was the same in many repeated cultures, on many years.
96. The emergence of antibiotic-resistant bacteria in a large CF clinic. P.J. Cook, D.E. Stableforth, D. Honeybourne, E.G. Smith. Adult CF Centre, Birmingham Heartlands Hospital, UK. We investigated the prevalence of chronic pulmonary infection with antibiotic-resistant bacteria in an adult CF unit. From September 1996 to December 1998, we examined 4,412 sputa
from 228 patients. 3 patients (1 ? 3%) had no positive cultures. 164 (71 ? 9%) had chronic infection with Ps aeruginosa. In 27 cases, (16 ? 5%) this was persistently sensitive to azlocillin, piperacillin, imipenem, aztreonam, ceftazidime, tobramycin and colistin, and in 50 (30 ? 5%), resistant only to 1 b-lactam, tobramycin or colistin. In 87 cases (53 ? 0%), it was resistant to tobramycin or colistin and $ 1 b-lactam, or to b-lactams of $ 2 types (penicillin, carbapenem, monobactam, ceftazidime). 37 patients (16 ? 2%) had chronic infection with Staph aureus, of which 18 strains (48 ? 6%) were persistently methicillin-resistant. 10 had Stenotrophomonas maltophilia, 8 Burkholderia cepacia, 5 Mycobacterium aviumintracellulare, 2 Alcaligenes spp, 1 Ralstonia picketii, 1 tobramycin-resistant Proteus mirabilis and 1 penicillin-resistant pneumococcus. We will demonstrate the increase in these organisms over 5 years, discussing the implications for an adult CF service and the usefulness of patient segregation.
97. Comparison of oropharyngeal, upper and lower respiratory tract bacterial flora ln patients with CF under the age of ´ ´ 1 Dept. of three years. P. Nevolova´ 1 , P. Pohunek 2 , V. Vavrova. 2 Pediatrics, Paediatric Pulmonology, UH Motol, Charles University, Prague, Czech Republic. Introduction: Prognosis of CF patients is mainly determined by lung infection. Microbial diagnosis is of extreme importance and should be based on lower respiratory tract secretions. It is difficult to obtain sputum from young children. Patients: We have retrospectively studied microbiological findings from 15 CF patients (8 boys, 7 girls) younger than three years (4 to 36 months, median 13 m) treated in our centre in the years 1996–1999. Methods: We have compared results of 61 throat swabs with nasolaryngeal (NL) suction and 11 NL suction cultures with bronchoscopic (B) samples. Samples growing significant pathogenic strains were considered positive. Results: 55 oropharyngeal (OP) cultures were negative and 6 positive, 22 NL cultures were negative and 39 positive. 33 NL cultures were positive with corresponding OP culture negative (54%). 6 NL cultures were negative and only 1 B culture was negative and 10 positive. Conclusions: OP cultures underestimate true rate of lower airways bacterial colonisation. In nonexpectorating patients NL suction is a good predictor of real colonisation and may be used for guiding the antibiotic therapy.
98. Analysis of microflora in upper and lower airways in adult CF patients in a simultaneous investigation. H. Kuprina, T. Sologub, E. Mitkina, T. Guembitskaia. State Research Centre for Pulmonology, St.-Petersburg, Russia. Knowing that upper and lower airways are closely connected and suffer from CF in equal degree. We have analysed results of complex microbiology investigation of sputum and brush-biopsy from nose and lower bronchi simultaneously in 12 adult CF pts (m-5, f-7, mean age 24.3 yrs) with severe course of disease and chronical rhinosinusitis. Our study has demonstrated that 11 pts had different combinations of bacteria in the sputum, nose and
Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84
Russian CF Centre. L. Shabalova, S. Polikarpova, O. Simonova, I. Osipova. Department of Cystic Fibrosis, Institute of Clinical Genetics, RAMS, Moscow, Russia. In 1998 we analysed the bacterial flora of sputum of 193 CF patients under 15 years. The sputum was collected by the cough or by deep throat swabs. The purpose of the study is the observation on the change of the composition of bacterial pathogens in CF patients of our centre and its sensitivity to antibiotics. Pseudomonas aeruginosa (PA) remains the most important pathogen in CF patients. Up to 75% of patients in the age 5 mth–15 y carry PA in the sputum. 56% of them have chronic PA lung infection. From 773 bacterial strains PA form 30%, St. aureus-29%, B. cepacia and Stenotrophomonas maltophilia – 2.5 and 2.5%%. The sensitivity (sensitive and intermediate) of PA sm. and muc. strains to amikacin, gentamicin, tobramycin, ciprofloxacin, ceftazidim, carbenicillin, colimycin – 88–75; 81–73; 95–88; 97–93; 59–60; 42–36; 96–96%% accordingly. The sensitivity of bacterial association of P.A. sm. 1 St. aureus and P.A. sm. 1 P.A. muc. 1 St. aureus to ciprofloxacin, gentamicin, amikacin and ceftazidim is 65–59; 62–52; 36–22; 0–0%% accordingly. Bukhoderia cepacia and Stenotrophomonas maltophilia sensitive (sensitive 1 intermediate) to amikacin, gentamicin, tobramycin, ciprofloxacin, ceftazidim, carbenicillin, colimycin in 16–22; 11–10; 22–11; 68–69; 53–34; 16–50; 43–44%% accordingly.
95. Bacterial pathogenes cultures in the CF children – A longitudinal study on 7 years. I. Popa 1 , L. Pop 1 , Z. Popa 2 . 1 Clinic II Paediatrics, University of Medicine and Pharmacy, Timisoara, 2 CF Centre Timisoara, Romania. A 7 years study on the pathogene germs in the CF children has been done. We assessed: the occurrence of one germ in the culture, bacterial association within the same culture, the presence of different germs in the same patient. From a lot of 32 CF patients, with their age rated between 0–17 years (average age 13.8 years), 62.5% showed positive repeated cultures. At a range of 4–6 cultures / year, we identified the following bacteria: P. aeruginosa (53.29%), S. aureus (35.54%), Klebsiella pneumoniae (11.17%), E. Coli (8.6%). Among the Pseudomonas species, the mucous ones represented 45%. 22% of the patients constantly had mixed infection. Among the patients with a single infection, 45% showed P. aeruginosa in the cultures, 37% S. aureus, 11% Klebsiella and 7% E. Coli. Conclusions: P. aeruginosa is the most frequent bacterium in the respiratory infection of the CF children; the mucous and non-mucous species have similar percentages; a relatively high incidence of other Gram-negative germs; in the mixed infection cases, the germs association was the same in many repeated cultures, on many years.
96. The emergence of antibiotic-resistant bacteria in a large CF clinic. P.J. Cook, D.E. Stableforth, D. Honeybourne, E.G. Smith. Adult CF Centre, Birmingham Heartlands Hospital, UK. We investigated the prevalence of chronic pulmonary infection with antibiotic-resistant bacteria in an adult CF unit. From September 1996 to December 1998, we examined 4,412 sputa
from 228 patients. 3 patients (1 ? 3%) had no positive cultures. 164 (71 ? 9%) had chronic infection with Ps aeruginosa. In 27 cases, (16 ? 5%) this was persistently sensitive to azlocillin, piperacillin, imipenem, aztreonam, ceftazidime, tobramycin and colistin, and in 50 (30 ? 5%), resistant only to 1 b-lactam, tobramycin or colistin. In 87 cases (53 ? 0%), it was resistant to tobramycin or colistin and $ 1 b-lactam, or to b-lactams of $ 2 types (penicillin, carbapenem, monobactam, ceftazidime). 37 patients (16 ? 2%) had chronic infection with Staph aureus, of which 18 strains (48 ? 6%) were persistently methicillin-resistant. 10 had Stenotrophomonas maltophilia, 8 Burkholderia cepacia, 5 Mycobacterium aviumintracellulare, 2 Alcaligenes spp, 1 Ralstonia picketii, 1 tobramycin-resistant Proteus mirabilis and 1 penicillin-resistant pneumococcus. We will demonstrate the increase in these organisms over 5 years, discussing the implications for an adult CF service and the usefulness of patient segregation.
97. Comparison of oropharyngeal, upper and lower respiratory tract bacterial flora ln patients with CF under the age of ´ ´ 1 Dept. of three years. P. Nevolova´ 1 , P. Pohunek 2 , V. Vavrova. 2 Pediatrics, Paediatric Pulmonology, UH Motol, Charles University, Prague, Czech Republic. Introduction: Prognosis of CF patients is mainly determined by lung infection. Microbial diagnosis is of extreme importance and should be based on lower respiratory tract secretions. It is difficult to obtain sputum from young children. Patients: We have retrospectively studied microbiological findings from 15 CF patients (8 boys, 7 girls) younger than three years (4 to 36 months, median 13 m) treated in our centre in the years 1996–1999. Methods: We have compared results of 61 throat swabs with nasolaryngeal (NL) suction and 11 NL suction cultures with bronchoscopic (B) samples. Samples growing significant pathogenic strains were considered positive. Results: 55 oropharyngeal (OP) cultures were negative and 6 positive, 22 NL cultures were negative and 39 positive. 33 NL cultures were positive with corresponding OP culture negative (54%). 6 NL cultures were negative and only 1 B culture was negative and 10 positive. Conclusions: OP cultures underestimate true rate of lower airways bacterial colonisation. In nonexpectorating patients NL suction is a good predictor of real colonisation and may be used for guiding the antibiotic therapy.
98. Analysis of microflora in upper and lower airways in adult CF patients in a simultaneous investigation. H. Kuprina, T. Sologub, E. Mitkina, T. Guembitskaia. State Research Centre for Pulmonology, St.-Petersburg, Russia. Knowing that upper and lower airways are closely connected and suffer from CF in equal degree. We have analysed results of complex microbiology investigation of sputum and brush-biopsy from nose and lower bronchi simultaneously in 12 adult CF pts (m-5, f-7, mean age 24.3 yrs) with severe course of disease and chronical rhinosinusitis. Our study has demonstrated that 11 pts had different combinations of bacteria in the sputum, nose and