Case 13

2020 ◽  
pp. 81-86
Author(s):  
Hilary Humphreys
Keyword(s):  
Cystic Fibrosis ◽  
Stenotrophomonas Maltophilia ◽  
New Technologies ◽  
Microbiology Laboratory ◽  
Oral Antibiotics ◽  
Flight Mass Spectrometry ◽  
Single Room ◽  
Inhaled Antibiotics ◽  
True Infection ◽  
Opportunist Pathogen

There is an increasing number of opportunist pathogens that may cause acute pulmonary exacerbations of cystic fibrosis as the patient cohort survives longer. However, it can often be difficult to determine if the isolation of these bacteria represents colonization or true infection. Their identification from sputum samples in the microbiology laboratory is also challenging, requires significant scientific expertise, and is assisted by new technologies such as MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). One such opportunist pathogen is Stenotrophomonas maltophilia, for which risk factors include increasing age and recent oral antibiotics, especially carbapenems. However, it is unclear if this bacterium is transmitted from patient to patient unlike with Pseudomonas aeruginosa, but all patients with cystic fibrosis should be admitted to a single room when hospitalization is required. Controversies exist regarding the optimal treatment which in the future may include a greater reliance on inhaled antibiotics.

scholarly journals Effect of pulmonary exacerbations treated with oral antibiotics on clinical outcomes in cystic fibrosis

Thorax ◽  
2016 ◽  
Vol 72 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Sanja Stanojevic ◽  
Alexandra McDonald ◽  
Valerie Waters ◽  
Sarah MacDonald ◽  
Eric Horton ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Outcomes ◽  
Oral Antibiotics ◽  
Pulmonary Exacerbations

22. Immune Response to Stenotrophomonas maltophilia in Cystic Fibrosis Patients

2018 ◽  
Author(s):  
Jillian Wettlaufer
Keyword(s):  
Cystic Fibrosis ◽  
Immune Response ◽  
Clinical Outcomes ◽  
Optical Density ◽  
Stenotrophomonas Maltophilia ◽  
Negative Control ◽  
Chronic Patients ◽  
Significant Difference ◽  
Antibody Levels ◽  
Sera Samples

Background: Stenotrophomonas maltophilia is one of the most common multidrug-resistant organisms isolated from the cystic fibrosis (CF) respiratory tract but it is unknown how it influences the long term clinical outcomes of CF patients.   Objective/Hypothesis: To characterize the immune response to S. maltophilia and its association with clinical outcomes in CF patients over time.  Methods: This was a longitudinal study from 2007-2014 of CF patients followed at The Hospital for Sick Children and St. Michael’s Hospital. All patients were classified as: 1) those with chronic S. maltophilia: ³2 positive cultures/year, 2) intermittent S. maltophilia: 1 positive sputum culture/year, and 3) no S. maltophilia cultures/year with and without chronic P. aeruginosa. IgG/IgA/IgM serologic responses were measured in serial sera samples by ELISA using whole cell S. maltophilia antigen. Results were calculated as the ratio of the average serum sample optical density to the average optical density of the negative control wells. Antibody levels for each patient were compared longitudinally to their rate of decline in FEV1 % predicted, body mass index, and rate of hospitalization.   Results: S. maltophilia antibody levels were measured in 350 sera samples from 113 CF patients. Median baseline antibody levels were 1.56 (range 0.996-5.15) in chronic patients, 1.09 (range 0.907-3.79) in intermittent patients, and 1.12 (range 0.737-4.86) in patients with no S. maltophilia.  Conclusions: Preliminary data suggests antibody levels to be significantly higher in patients with chronic S. maltophilia, and no significant difference between intermittent S. maltophilia and no S. maltophilia.

REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION

2016 ◽  
Vol 101 (9) ◽  
pp. e2.6-e2
Author(s):  
Gabis Chana ◽  
Michelle Tabberner ◽  
Wendy Nixon ◽  
Sue Frost ◽  
Leslie Barrett ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Medical Condition ◽  
Junior Doctors ◽  
Positive Contribution ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
National Guidelines ◽  
Exclusion Criteria ◽  
Patient Journey ◽  
Telephone Advice

AimWith pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices.MethodThe requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria.ResultsA total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form.ConclusionOverall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed.

scholarly journals Unsupervised Phenotypic Clustering for Determining Clinical Status in Children with Cystic Fibrosis

2021 ◽  
pp. 2002881
Author(s):  
Nicole Filipow ◽  
Gwyneth Davies ◽  
Eleanor Main ◽  
Neil J. Sebire ◽  
Colin Wallis ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cystic Fibrosis ◽  
Lung Function ◽  
Disease Severity ◽  
Learning Algorithm ◽  
Severe Disease ◽  
Clinical Status ◽  
Oral Antibiotics ◽  
Multisystem Disease ◽  
Street Hospital

BackgroundCystic Fibrosis (CF) is a multisystem disease in which assessing disease severity based on lung function alone may not be appropriate. The aim of the study was to develop a comprehensive machine-learning algorithm to assess clinical status independent of lung function in children.MethodsA comprehensive prospectively collected clinical database (Toronto, Canada) was used to apply unsupervised cluster analysis. The defined clusters were then compared by current and future lung function, risk of future hospitalisation, and risk of future pulmonary exacerbation (PEx) treated with oral antibiotics. A K-Nearest Neighbours (KNN) algorithm was used to prospectively assign clusters. The methods were validated in a paediatric clinical CF dataset from Great Ormond Street Hospital (GOSH).ResultsThe optimal cluster model identified four (A-D) phenotypic clusters based on 12 200 encounters from 530 individuals. Two clusters (A,B) consistent with mild disease were identified with high FEV1, and low risk of both hospitalisation and PEx treated with oral antibiotics. Two clusters (C,D) consistent with severe disease were also identified with low FEV1. Cluster D had the shortest time to both hospitalisation and PEx treated with oral antibiotics. The outcomes were consistent in 3124 encounters from 171 children at GOSH. The KNN cluster allocation error rate was low, at 2.5% (Toronto), and 3.5% (GOSH).ConclusionMachine learning derived phenotypic clusters can predict disease severity independent of lung function and could be used in conjunction with functional measures to predict future disease trajectories in CF patients.

scholarly journals Epidemiology of cystic fibrosis respiratory pathogens isolated at a South African Hospital, 2006–2010

2016 ◽  
Vol 31 (4) ◽  
pp. 106-111
Author(s):  
Vindana Chibabhai ◽  
Warren Lowman
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
South African ◽  
Burkholderia Cepacia ◽  
Stenotrophomonas Maltophilia ◽  
Burkholderia Cepacia Complex ◽  
Respiratory Pathogens ◽  
Academic Hospital ◽  
Cystic Fibrosis Population ◽  
Susceptibility Patterns

Background: The epidemiology of cystic fibrosis (CF) associated pathogens other than Pseudomonas aeruginosa in the South African cystic fibrosis population has not been previously described.Methods: A retrospective review of respiratory cultures taken from cystic fibrosis clinic patients at the Charlotte Maxeke Johannesburg Academic Hospital from 2006 to 2010 was performed.Results: During the study period, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia complex and Candida albicans prevalence remained stable, Aspergillus fumigatus increased from 8% to 20% (p = 0.0132); Staphylococcus aureus decreased from 66% to 50% (p = 0.0243) and Haemophilus influenzae decreased from 13% to 3% (p = 0.0136). There were significant antimicrobial susceptibility changes to meropenem (p  0.0001) amongst P. aeruginosa isolates and cloxacillin (p 0.0001) amongst S. aureus isolates. Prevalence of most bacterial pathogens appeared to increase with increasing age.Conclusion: The findings of this study illustrate the epidemiology of CF associated respiratory pathogens and the trends in prevalence and susceptibility patterns over a 5-year period.

scholarly journals Cooperative pathogenicity in cystic fibrosis: Stenotrophomonas maltophilia modulates Pseudomonas aeruginosa virulence in mixed biofilm

2015 ◽  
Vol 6 ◽  
Author(s):  
Arianna Pompilio ◽  
Valentina Crocetta ◽  
Serena De Nicola ◽  
Fabio Verginelli ◽  
Ersilia Fiscarelli ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Stenotrophomonas Maltophilia

A novel highly charged exopolysaccharide produced by two strains of Stenotrophomonas maltophilia recovered from patients with cystic fibrosis

2011 ◽  
Vol 346 (13) ◽  
pp. 1916-1923 ◽  
Author(s):  
Paola Cescutti ◽  
Bruno Cuzzi ◽  
Gianfranco Liut ◽  
Christine Segonds ◽  
Giovanni Di Bonaventura ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Stenotrophomonas Maltophilia
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