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Recurrent respiratory infections account for most of the morbidity and mortality of cystic fibrosis patients.
The objective was to determine the prevalence of pathogens isolated from lower respiratory tract secretions in cystic fibrosis patients. In this descriptive observational study, data from 69 patients was collected from medical records.
The...
Contexts in source publication
Context 1
... mean age was 10.8+13.5 years (median 5 and amplitude of 0.1-59 years); 75% of the patients were diagnosed during childhood (≤16 years of age) and 25% as adults (>16 years of age); 53.7% were male; 33.9% were white, 62% mulatto and 3.3% were black. Table 1 shows the general characteristics of the population and Table 2 shows the prevalence of pathogens identified in the first culture of secretions from lower airways. ...
Context 2
... from the National Cystic Fibrosis Registry in 1996, which included 17,620 cystic fibrosis patients showed that 59.9% were positive for P. aeruginosa, 37.5% for S. aureus, 15.4% for H. influenzae, 3.6% for B. cepacea and 3.9% for S. maltophilia.1 In our study, we found similar pathogens, but with lower prevalences than those observed in the above study (Table 1); this could be due to differences in the size and origin of the samples. When prevalence was evaluated by age group, we observed that P. aeruginosa increased with age, but with a high prevalence of around 20%during the first years. ...
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Citations
... Our results come in agreement with a Spanish study that showed that 94.1% of MRSA isolates were biofilm formers [28]. Biofilm production was also reported at 76.5%, 67% and 72.5% of P. aeruginosa, S. aureus and K. pneumoniae isolated from patients with CF in Brazil, respectively [29]. ...
Background
Notable emergence of multidrug-resistant bacteria has become increasingly problematic worldwide. Most patients with cystic fibrosis (CF) suffer from chronic persistent infections with frequent occurrence of acute exacerbations. Routine screening of bacterial strains, epidemiological characteristics, and resistance patterns are particularly useful for patient management and maintenance of infection control procedures
Methods
In this study, 43 pharyngeal samples were taken from patients with CF. Microbiological bacterial culture and identification, antimicrobial susceptibility testings, biofilm formation, including minimum biofilm eradication concentration (MBEC) and PCR for detecting resistance genes were performed.
Results
All samples were positive for bacterial growth. The predominant species were Staphylococcus aureus (41.86%; n = 18) and Pseudomonas aeruginosa (39.53%; n = 17). 30% of isolated bacteria were multidrug-resistant, resisting high concentrations of tested antibiotics. Among the 42 biofilm-forming isolates, 23.8% (n = 10) were strong biofilm formers. The occurance of resistance genes varied with blaKPC detected in 71% (n = 17) of all Gram-negative isolates and mecA found in 61% (n = 11) of all S. aureus strains.
Conclusions
The majority of isolated bacteria were S. aureus and P. aeruginosa. The high frequency of antimicrobial resistance, the presence of resistance genes, and biofilm formation highlight the challenge in treatment and infection control measures in patients with CF.
KEY MESSAGES
Staphylococcus aureus and Pseudomonas aeruginosa are the most prevalent pathogens found in patients with CF in Jordan.
Detection of antimicrobial resistance genes in patients with CF confirms that antimicrobial resistance patterns must always be monitored.
Biofilm formation significantly increases the tolerance of bacteria to antimicrobial agents.
... This mucus facilitates the entrapment of viruses, bacteria, and fungal spores and acts as a suitable environment for growth of these microorganisms [4]. High morbidity and mortality rates are secondary to recurrent respiratory infections, which, when associated with this obstructive lung disease, lead to respiratory insufficiency [5]. Complex microorganisms and microbial communities can be identified in the distal airways in a variety of respiratory diseases, including CF [6]. ...
... High morbidity and mortality rates in cystic fibrosis patients are secondary to recurrent respiratory infections, which, when associated with this obstructive lung disease, lead to respiratory insufficiency, the main cause of death in these patients [5,14]. ...
Cystic fibrosis (CF) is a multisystem genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Microbial infection is the defined characteristics of cystic fibrosis airway disease. This infection is caused by bacteria, fungi, and viruses which increase complications leading to patient death. Additionally, bacterial pathogens including Haemophilus influenza, Staphylococcus aureus, Pseudomonas aeruginosa, nontuberculous mycobacterium (NTM) species, and MRSA are attributed to pulmonary infections. Subsequently, fungal pathogens such as Candida sp. and filamentous fungi such as Aspergillus fumigatus can also lead to pulmonary infections. On the other hand, Pseudomonas aeruginosa is the most common bacterial pathogen leading to complications in CF distal airways disease. Also, Aspergillus fumigatus can lead to aspergillus lung diseases including allergic bronchopulmonary aspergillosis and aspergilloma formation. Control of pathogenic microorganisms associated with cystic fibrosis may prevent pulmonary complications and has the potential to improve the prognosis of this life-limiting disease.
... At least one of the microbial agents was identified in 68 children (65.3%). In studies from various parts of the world, Pseudomonas was the predominant bacteria [15][16][17][18] . The percentage of children who grew Pseudomonas in our study was 29.8 per cent, which was lesser than the results of a study (36%) from Bcc was another important pathogen, isolated from three (2.8%) patients. ...
... The yield of Staphylococcus spp. in our study was only 1.9 per cent whereas other studies reported as high as 78 per cent 15,[22][23][24] . In the STOP study, methicillin-resistant S. aureus was detected in 39 per cent whereas methicillin-susceptible S. aureus was detected in 36 per cent of study population 21 27,28 . ...
Background & objectives: Pulmonary disease is the main cause of morbidity and mortality in cystic fibrosis (CF). The infection occurs with a unique spectrum of bacterial pathogens that are usually acquired in an age-dependent fashion. The objective of this study was to find out the aetiological agents in respiratory specimens from children with CF during pulmonary exacerbation and relate with demographic variables.
Methods: In this observational study, airway secretions from children (n=104) with CF presenting with pulmonary exacerbations were collected and tested for bacteria, fungi, mycobacteria and viral pathogens using appropriate laboratory techniques. The frequencies of isolation of various organisms were calculated and associated with various demographic profiles.
Results: Bacteria were isolated in 37 (35.5%) and viral RNA in 27 (29.3%) children. Pseudomonas was the most common bacteria grown in 31 (29.8%) followed by Burkholderia cepacia complex (Bcc) in three (2.8%) patients. Among viruses, Rhinovirus was the most common, identified in 16 (17.4%) samples followed by coronavirus in four (4.3%). Fungi and mycobacteria were isolated from 23 (22.1%) and four (3.8%) children, respectively. Aspergillus flavus was the most common fungus isolated in 13 (12.5%) children.
Interpretation & conclusions: Pseudomonas was the most common organism isolated during exacerbation. Non-tuberculous mycobacteria were not isolated, whereas infection with Bcc and Mycobacterium tuberculosis was observed, which could probably have a role in CF morbidity. Polymicrobial infections were associated with severe exacerbations.
... In adults, Pseudomonas aeruginosa and Staphylococcus aureus are the most frequent microorganisms. 8 Recent reports document an increasing incidence of new Gram-negative pathogens such as Stenotrophomonas maltophilia, Alcaligenes xylosoxidans and Burkholderia cepacia complex. 9 Even when aggressive treatment of the respiratory disease is employed, there is a progressive decline in lung function, with a moderate-severe impairment present in 60% of adults. ...
Introduction:
The incidence of cystic fibrosis (CF) in Portugal is estimated at 1:8000 live births, although there is a lack of accurate statistics. The average life expectancy has been steadily increasing and CF is no longer an exclusively pediatric disease.
Objectives:
Characterize the Portuguese adult population with the diagnosis of CF.
Methods:
Retrospective study based on clinical data of adult CF follow-up patients in the three specialized centers in Portugal where all of CF patients are seen, during 2012.
Results:
In 2012, there were 89 follow-up patients, 48 (54%) female and 15 (17%) lung transplanted. The average age was 31.3±9 years. The median age at diagnosis was 13 years and 34 (38%) were diagnosed in adulthood. The most frequent mutation was F508del (54.9%). Of the 89 patients, 49 patients (56%) had pancreatic insufficiency, 7 (9%) were diabetic and 42 patients (47.7%) had a body mass index (BMI) <20kg/m(2). As to ventilatory function, the average value of the forced expiratory volume in 1s (FEV1) was 58.45±28.59%. Only one of 77 patients did not have chronic airway infection. The most commonly isolated germ was methicillin-sensitive Staphylococcus aureus in 49 patients (55%). During 2012, two patients (2.2%) died at the ages of 21 and 36 years.
Discussion:
This study is the first description of the Portuguese adult CF population, which is particularly important since it can give us a better understanding of the real situation. A significant percentage of these patients were diagnosed in adulthood, which highlights the need for diagnostic suspicion in a patient with chronic lung disease and atypical manifestations.
... For the reasons that are not fully understood well, CF airways can be colonized simultaneously with different members of Gammaproteobacteria including Pseudomonas aeruginosa, Haemophilus influenzae, Stenotrophomonas maltophilia, Achromobacter (Alcaligenes) xylosoxidans, Klebsiella pneumoniae and Escherichia coli (a commensal resident of the human gut). [8][9][10][11][12][13][14][15][16][17][18][19][20] Gammaproteobacteria comprise several medically and ecologically important species, distributed in Enterobacteriaceae, Pseudomonadaceae and Vibrionaceae orders. A high level of metabolic pathway conservation has been detected in this group of bacteria. ...
Gene co-expression analysis is one of the main aspects of systems biology that uses high-throughput gene expression data. In the present study we applied cross-species co-expressional analysis on a module of biofilm and stress response associated genes. We addressed different kinds of stresses in three most intensively studied members of Gammaproteobacteria including Escherichia coli K12, Pseudomonas aeruginosa PAO1 and Salmonella enterica for which large sets of gene expression data are available. Our aim was to evaluate the presence of common stress response strategies adopted by these microorganisms that may be assigned to the other members of Gammaproteobacteria. Results of functional annotation analysis revealed distinct categories among co-expressed genes, most of which concerned biological processes associated with virulence and stress response. Transcriptional regulatory analysis of genes present in co-expressed modules showed that the global stress sigma factor, RpoS, besides several local transcription factors accounts for the observed co-expressional response, and that several cases of feed-forward loops exist between global regulators, local transcription factors and their targets. Our results lend partial support to our underlying assumption of the conservation of core biological processes and regulatory interactions among these related Gammaproteobacteria members. This has led to the implementation of transferring gene function annotations from well-studied Gammaproteobacterial species to less-characterized members. These findings can shed light on the discovery of new drug targets capable of controlling severe infections caused by these groups of bacteria.
... In the 30s, when the CF was described, 80% of children died in the first years of life. In 1980, the survival rate increased to 20 years, reaching 28 in the 90s and in 2001 reached 32 years old [29]. ...
Modifier genes, as the TNF-α gene, can modulate the cystic fibrosis (CF) severity. Thus, -238G>A and -308G>A polymorphisms of TNF-α gene were analyzed as modifiers of CF. In this context, the present study enrolled 49 CF patients (diagnosis performed by sweat test and complete CFTR screening). The -238G>A polymorphism analysis was performed by ARMS-PCR, and -308G>A, by PCR-RFLP. In our data, the -238G>A polymorphism was not associated with clinical variability. The AA genotype for -308G>A polymorphism was a risk factor for early gastrointestinal symptoms (OR=5.98, 95%CI=1.06-49.68) and protection for the first Pseudomonas aeruginosa (OR=0.05, 95%CI=0.0003-0.007). For the first P. aeruginosa, GA genotype was a risk factor (OR=10.2, 95%CI=1.86-84.09); for the same genotype, the diagnosis was made in minor time than the AA genotype (p=0.031). Considering the -308G>A polymorphism alleles, the G allele was a risk factor for early pulmonary symptoms (OR=3.81, 95%CI=1.13-12.97) and P. aeruginosa (OR=66.77, 95%CI=15.18-482.7); however, the same allele showed better transcutaneous oxygen saturation (OR=9.24, 95%CI=1.53-206.1). The A allele was a protective factor for early pulmonary symptoms (OR=12.26, 95%CI=0.08-0.89) and P. aeruginosa (OR=12.15, 95%CI=0002-0007), however, the same allele was a risk factor for worst transcutaneous oxygen saturation (OR=7.01, 95%CI=1.14-157.4). As conclusion, the -308G>A polymorphism of the TNF-α gene was associated with the CF severity.
... Lower respiratory tract infection is a major cause of morbidity and mortality in patients with CF. 5 Pseudomonas aeruginosa is the most prevalent bacteria in death-related pulmonary infection. [6][7][8] It is also a common pathogen in chronic rhinosinusitis (CRS). 9 In patients with CF, radiographic evidence of sinusitis is almost universally detected. ...
Lower airway infection is a major cause of morbidity and mortality in patients with cystic fibrosis. It is currently unknown if the infection of the upper airway can cause exacerbation of lower respiratory tract infection. This study aimed to determine the microbiological profile of the anterior paranasal sinuses outflow tract (middle meatus) of cystic fibrosis outpatients. The microbiological profile was defined using endoscopically directed middle meatal cultures. Paired middle meatal and sputum specimens were collected from 56 outpatients for aerobic cultures. A semi-quantitative leukocyte count of the middle meatal samples was performed. The median age of patients was nine years (3-20 years). Staphylococcus aureus (37%), Staphylococcus coagulase-negative (25%), Neisseriac (14%), Pseudomonas aeruginosa (11%), and Streptococcus pneumoniae (7%) were the most prevalent microorganisms in the middle meatal cultures. Using the middle meatal leukocyte count, 16 out of 54 patients (29.6%) presented sinus infection. The most frequent pathogens identified from patients with sinus infection were Staphylococcus aureus (62%), Pseudomonas aeruginosa (25%), and Streptococcus pneumoniae (18%). Agreement of paired middle meatal and sputum cultures was significantly higher among patients with infection in middle meatal (69%). The most common middle meatal pathogens were the typical cystic fibrosis spectrum. This suggests the potential for participating in post-nasal lower airway seeding.
... During the initial stage of the disease the strains of this species without a mucous capsule, colonize the airways. In chronic infection, conversion of P. aeruginosa strains into mucous form is observed; this phenotype is connected with increased secretion of exocellular polysaccharides [17][18][19]. These strains demonstrate the change of the colony's morphology, the change of lipopolysaccharide (LPS) from smooth form into a rough one, resulting from shortened O-specific chains, and a limited proteolytic activity. ...
... It was shown in this paper that the second, in respect of prevalence, microorganism isolated from patients was S. aureus. These data are similar to other reports, in which the frequency of colonization by S. aureus strains ranged from 10.1% to 57.0% [17,27,28,30,32]. ...
... The results obtained in this paper confirm that in the group of adult patients the proportion of isolated Haemophilus was low, in the material taken from 7.9% of patients. According to the literature, the proportion of adult patients from whom this species was isolated varied from 1.5% to 24.0% [17,30,32,36]. ...
Introduction:
Cystic fibrosis (CF) is the most common genetic autosomal recessive genetic disease. The most serious symptoms are observed in the lungs. Recurrent respiratory infections are the main causes of the hospitalizations and deaths of cystic fibrosis patients. Pathogens that commonly infect the airways of adult CF patients include Staphylococcus aureus and Pseudomonas aeruginosa. The aim of this study was to analyse the microorganisms cultured from the airways of adult CF patients and to test the antimicrobial resistance of the most frequently isolated bacteria.
Material and methods:
In this study, 1422 isolates of 89 CF patients were collected during a 4-year period. The microorganisms were cultured and identified according to standard microbiological procedures. Identification and drug susceptibility were performed in an automatic system Phoenix (BD), Vitek2Compact (bioMérieux), and disk-diffusion method by Kirby-Bauer.
Results:
Among the 1422 strains the most frequent pathogens were Pseudomonas aeruginosa (55.6%) and Staphylococcus aureus (37.8%). A total of 482 (61.0%) strains of 790 isolates of P. aeruginosa, were identified as P. aeruginosa mucoid phenotype. The isolates with mucoid phenotypes were more susceptible to antibiotics than non-mucoid. Eighty-six strains of S. aureus showed resistance to methicillin (MRSA), which accounted for 16.0% of all strains of S. aureus.
Conclusions:
The analysis of microbiological materials from adult CF patients treated in IGiChP allowed the determination of the prevalence of potentially pathogenic microorganisms. The data obtained are consistent with the literature.
... In this study, the main pathogen in patients with chronic pulmonary infections was P. aeruginosa. Although treatment and antibiotic prophylaxis have decreased morbidity and mortality in CF patients, the problem of resistance to antibiotics for P. aeruginosa still exists (9)(10)(11)(12). Despite treatment, P. aeruginosa can remain in the lungs of CF patients and lead to serious problems. ...
... Pseudomonas aeruginosa is a ubiquitous gram-negative bacterium, which plays an important role in the pathogenesis of the cystic fibrosis lung disease in humans, especially in young children who have been demonstrated to be at risk of early P. aeruginosa colonization (McKay et al., 2009). A study has reported a high prevalence (83%) of P. aeruginosa in Brazilian pediatric patients with cystic fibrosis under 2 years of age (Santana et al., 2003). However, only one case report revealed the ability of iron to facilitate P. aeruginosa lung infection in adult patients (Berlutti et al., 2005). ...
Iron constitutes a critical nutrient source for bacterial growth, so iron overload is a risk factor for bacterial infections. This study aimed at investigating the role of iron overload in modulating bacterial endotoxin-induced lung inflammation. Weaning male Wistar rats were intraperitoneally injected with saline or iron sucrose [15 mg kg(-1) body weight (bw), 3 times per week, 4 weeks]. They were then intratracheally injected with Pseudomonas aeruginosa lipopolysaccharide (LPS) (5 μg kg(-1) bw) or saline. Inflammatory indices were evaluated 4 or 18 h post-LPS/saline injection. At 4 h, LPS-treated groups revealed significant increases in the majority of inflammatory parameters (LPS-binding protein (LBP), immune cell recruitment, inflammatory cytokine synthesis, myeloperoxidase activity, and alteration of alveolar-capillary permeability), as compared with control groups. At 18 h, these parameters reduced strongly with the exception for LBP content and interleukin (IL)-10. In parallel, iron acted as a modulator of immune cell recruitment; LBP, tumor necrosis factor-α, cytokine-induced neutrophil chemoattractant 3, and IL-10 synthesis; and alveolar-capillary permeability. Therefore, P. aeruginosa LPS may only act as an acute lung inflammatory molecule, and iron overload may modulate lung inflammation by enhancing different inflammatory parameters. Thus, therapy for iron overload may be a novel and efficacious approach for the prevention and treatment of bacterial lung inflammations.
