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WS19.9 A prospective multicenter study to dissect Staphylococcus aureus-colonization from infection in cystic fibrosis patients
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Workshop 19. Clinical perspectives
WS19.9 A prospective multicenter study to dissect Staphylococcus aureus-colonization from infection in cystic fibrosis patients S. Junge1 , B. Wiedemann2 , B. T¨ummler1 , A. D¨ubbers3 , P. K¨uster4 , J. Nofer5 , H. Ellemunter6 , J.G. Mainz7 , E. Heuer8 , W. Sextro8 , C. K¨orner-Rettberg9 , M. Ballmann9 , U. Mellies10 , J. Hammermann11 , H. Teschler12 , R. Szczepanski13 , F.K. Tegtmeyer14 , U. Graepler-Mainka15 , J. Riethmueller15 , A. Wald16 , B. Wollschl¨ager17 , D. Staab18 , A. Schuster19 , K. Becker20 , G. Peters20 , B.C. Kahl20 . 1 Medizinische Hochschule Hannover, Hannover, Germany; 2 University Dresden, Medical Informatics and Biometrics, Dresden, Germany; 3 University Clinics Muenster, Pediatrics, M¨unster, Germany; 4 Clemenshospital M¨unster, Pediatrics, M¨unster, Germany; 5 University Clinics Muenster, Laboratory Medicine, M¨unster, Germany; 6 Medical University Innsbruck, Pediatrics, Innsbruck, Austria; 7 University Clinics Jena, Cystic Fibrosis, Jena, Germany; 8 Cystic Fibrosis Center, Hamburg, Germany; 9 University Clinics Bochum, Pediatrics, Bochum, Germany; 10 University Clinics Essen, Pediatrics, Essen, Germany; 11 University Clinics Dresden, Pediatrics, Dresden, Germany; 12 Ruhrlandklinik, Cystic Fibrosis, Essen, Germany; 13 Children’s Hospital Osnabr¨uck, Cystic Fibrosis, Osnabr¨uck, Germany; 14 Children’s hospital Park Sch¨onfeld, Cystic Fibrosis, Kassel, Germany; 15 University Clinics T¨ubingen, Pediatrics, T¨ubingen, Germany; 16 University Clinics Leipzig, Cystic Fibrosis, Leipzig, Germany; 17 University Clinics Halle, Cystic Fibrosis, Halle, Germany; 18 Charit´e Universit¨atsmedizin Berlin, Cystic Fibrosis, Berlin, Germany; 19 University Clinics D¨usseldorf, Pediatrics, D¨usseldorf, Germany; 20 University Clinics Muenster, Medical Microbiology, M¨unster, Germany Objectives: The aim of this prospective longitudinal multicenter study was to dissect colonization from infection in patients with Staphylococcus aureus cultured from the airways by determining a variety of host- and pathogen-specific parameters. Methods: Inclusion criteria: >6 years, persistent S. aureus cultures from airway specimens. Specimens were processed at the study laboratory in Muenster. Clincal data, lung function and antibiotic therapy were recorded. Sera were taken once a year and during exacerbations. Microbiological processing included determination of the density of microorganisms. Isolates were molecular typed by spa-typing. Prevalence of important virulence genes was assessed by single and multiplex PCR. Results: Data were collected for 195 patients from 17 centers in Germany and Austria: 75 female (38.5%); mean age 15.7 years (range 5 to 41 y), 49% DF508 homozygous. Data from 1359 visits were evaluated (mean visits/patient 7). There was a significant correlation of bacterial density (> or <1×105 CFU/ml) and lung function FEV1 (p = 0.017). S. aureus nasal carriers had better lung functions compared to non-carriers, but had a steeper decline of FEV1 %. IL-6 values were significantly higher in patients with high bacterial loads in sputum cultures. Most patients carried their individual clones. Some virulence factors seem to be associated with CF isolates. Conclusion: There was a significant correlation of lung function, IL-6 values and bacterial density in sputa. Future studies should determine, if patients will benefit from antibiotic treatment, which is guided by determining the bacterial load in airway specimens.
Oral Presentations
Workshop 19. Clinical perspectives
WS19.9 A prospective multicenter study to dissect Staphylococcus aureus-colonization from infection in cystic fibrosis patients S. Junge1 , B. Wiedemann2 , B. T¨ummler1 , A. D¨ubbers3 , P. K¨uster4 , J. Nofer5 , H. Ellemunter6 , J.G. Mainz7 , E. Heuer8 , W. Sextro8 , C. K¨orner-Rettberg9 , M. Ballmann9 , U. Mellies10 , J. Hammermann11 , H. Teschler12 , R. Szczepanski13 , F.K. Tegtmeyer14 , U. Graepler-Mainka15 , J. Riethmueller15 , A. Wald16 , B. Wollschl¨ager17 , D. Staab18 , A. Schuster19 , K. Becker20 , G. Peters20 , B.C. Kahl20 . 1 Medizinische Hochschule Hannover, Hannover, Germany; 2 University Dresden, Medical Informatics and Biometrics, Dresden, Germany; 3 University Clinics Muenster, Pediatrics, M¨unster, Germany; 4 Clemenshospital M¨unster, Pediatrics, M¨unster, Germany; 5 University Clinics Muenster, Laboratory Medicine, M¨unster, Germany; 6 Medical University Innsbruck, Pediatrics, Innsbruck, Austria; 7 University Clinics Jena, Cystic Fibrosis, Jena, Germany; 8 Cystic Fibrosis Center, Hamburg, Germany; 9 University Clinics Bochum, Pediatrics, Bochum, Germany; 10 University Clinics Essen, Pediatrics, Essen, Germany; 11 University Clinics Dresden, Pediatrics, Dresden, Germany; 12 Ruhrlandklinik, Cystic Fibrosis, Essen, Germany; 13 Children’s Hospital Osnabr¨uck, Cystic Fibrosis, Osnabr¨uck, Germany; 14 Children’s hospital Park Sch¨onfeld, Cystic Fibrosis, Kassel, Germany; 15 University Clinics T¨ubingen, Pediatrics, T¨ubingen, Germany; 16 University Clinics Leipzig, Cystic Fibrosis, Leipzig, Germany; 17 University Clinics Halle, Cystic Fibrosis, Halle, Germany; 18 Charit´e Universit¨atsmedizin Berlin, Cystic Fibrosis, Berlin, Germany; 19 University Clinics D¨usseldorf, Pediatrics, D¨usseldorf, Germany; 20 University Clinics Muenster, Medical Microbiology, M¨unster, Germany Objectives: The aim of this prospective longitudinal multicenter study was to dissect colonization from infection in patients with Staphylococcus aureus cultured from the airways by determining a variety of host- and pathogen-specific parameters. Methods: Inclusion criteria: >6 years, persistent S. aureus cultures from airway specimens. Specimens were processed at the study laboratory in Muenster. Clincal data, lung function and antibiotic therapy were recorded. Sera were taken once a year and during exacerbations. Microbiological processing included determination of the density of microorganisms. Isolates were molecular typed by spa-typing. Prevalence of important virulence genes was assessed by single and multiplex PCR. Results: Data were collected for 195 patients from 17 centers in Germany and Austria: 75 female (38.5%); mean age 15.7 years (range 5 to 41 y), 49% DF508 homozygous. Data from 1359 visits were evaluated (mean visits/patient 7). There was a significant correlation of bacterial density (> or <1×105 CFU/ml) and lung function FEV1 (p = 0.017). S. aureus nasal carriers had better lung functions compared to non-carriers, but had a steeper decline of FEV1 %. IL-6 values were significantly higher in patients with high bacterial loads in sputum cultures. Most patients carried their individual clones. Some virulence factors seem to be associated with CF isolates. Conclusion: There was a significant correlation of lung function, IL-6 values and bacterial density in sputa. Future studies should determine, if patients will benefit from antibiotic treatment, which is guided by determining the bacterial load in airway specimens.
Oral Presentations