Serum Bactericidal Test as a Prognostic Indicator in Acute Pulmonary Exacerbations of Cystic Fibrosis

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 451-455
Author(s):  
Pierre Cahen ◽  
Christine Coustère ◽  
Pascale Nicaise ◽  
Michel Vèron ◽  
Jean-Louis Gaillard ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Predictive Value ◽  
Bacterial Infections ◽  
Statistical Significance ◽  
Age Groups ◽  
Prognostic Indicator ◽  
Trough Serum ◽  
Peak Titer ◽  
Pulmonary Exacerbations

The serum bactericidal test has been used for many years for optimal assessment of the efficacy of antibiotic therapy in patients with infective endocarditis and other bacterial infections. Its capacity to predict the bacteriological outcome of acute pulmonary exacerbations in patients with cystic fibrosis was evaluated. A total of 54 courses of intravenous antibiotic therapy were analyzed in 22 patients, whose ages ranged from 4 months to 24 years (mean age: 10 years). The serum bactericidal activity of blood samples, taken at expected peak and trough antibiotic levels on day 4 of therapy, were determined against the potentially pathogenic strains isolated in sputum at the time of admission. For 104 isolates (64 Pseudomonas aeruginosa, 28 Staphulococcus aureus, and 12 Haemophilus influenzae strains), the peak and trough bactericidal titers were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 units or more in the bacterial density in sputum between days 0 and 7 of therapy. At peak antibiotic levels, serum bactericidal titers of 1:128 or more were 96% (all isolates) and 89% (P aeruginosa isolates), predictive of cure, whereas serum bactericidal titers of less than 1:16 were 100% predictive of failure for all infecting bacteria. In patients aged less than 18 years, the best peak titer for predicting success was 1:64, with a predictive value of 96% for titers of 1:64 or greater The peak titer that best predicted success in patients aged 18 years or more was 1:128, with a predictive value of only 83% for titers of 1:128 or greater. No trough serum bactericidal titer achieved statistical significance as a predictor of bacteriological outcome in the two patient age groups. Peak serum bactericidal titers of 1:64 or more (patients aged less than 18 years) and of 1:128 or more (patients aged 18 years or more) are recommended to provide optimal treatment of acute pulmonary exacerbations of cystic fibrosis.

scholarly journals A first-year dornase alfa treatment impact on clinical parameters of patients with cystic fibrosis: the Brazilian cystic fibrosis multicenter study

2013 ◽  
Vol 31 (4) ◽  
pp. 420-430 ◽  
Author(s):  
Tatiana Rozov ◽  
Fernando Antônio A. e Silva ◽  
Maria Angélica Santana ◽  
Fabíola Villac Adde ◽  
Rita Heloisa Mendes
Keyword(s):  
Cystic Fibrosis ◽  
Emergency Room ◽  
Age Groups ◽  
Forced Expiratory Volume ◽  
First Year ◽  
Age Group ◽  
Emergency Room Visits ◽  
Dornase Alfa ◽  
Pulmonary Exacerbations ◽  
One Year

OBJECTIVE: To describe the clinical impact of the first year treatment with dornase alfa, according to age groups, in a cohort of Brazilian Cystic Fibrosis (CF) patients. METHODS: The data on 152 eligible patients, from 16 CF reference centers, that answered the medical questionnaires and performed laboratory tests at baseline (T0), and at six (T2) and 12 (T4) months after dornase alfa initiation, were analyzed. Three age groups were assessed: six to 11, 12 to 13, and >14 years. Pulmonary tests, airway microbiology, emergency room visits, hospitalizations, emergency and routine treatments were evaluated. Student's t-test, chi-square test and analysis of variance were used when appropriated. RESULTS: Routine treatments were based on respiratory physical therapy, regular exercises, pancreatic enzymes, vitamins, bronchodilators, corticosteroids, and antibiotics. In the six months prior the study (T0 phase), hospitalizations for pulmonary exacerbations occurred in 38.0, 10.0 and 61.4% in the three age groups, respectively. After one year of intervention, there was a significant reduction in the number of emergency room visits in the six to 11 years group. There were no significant changes in forced expiratory volume in one second (VEF1), in forced vital capacity (FVC), in oxygen saturation (SpO2), and in Tiffenau index for all age groups. A significant improvement in Shwachman-Kulczychi score was observed in the older group. In the last six months of therapy, chronic or intermittent colonization by P. aeruginosa was detected in 75.0, 71.4 and 62.5% of the studied groups, respectively, while S. aureus colonization was identified in 68.6, 66.6 and 41.9% of the cases. CONCLUSIONS: The treatment with dornase alfa promoted the maintenance of pulmonary function parameters and was associated with a significant reduction of emergency room visits due to pulmonary exacerbations in the six to 11 years age group, with better clinical scores in the >14 age group, one year after the intervention.

scholarly journals Effect of continuous-infusion antibiotic therapy on pulmonary function of patients with cystic fibrosis: A cross-sectional study

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1766
Author(s):  
Somaya Albhaisi ◽  
Fei-Pi Lin ◽  
Nauman Chaudary
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Pulmonary Function ◽  
Continuous Infusion ◽  
Intermittent Infusion ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Pulmonary Exacerbations ◽  
Infusion Protocol

Background: Cystic fibrosis (CF) is associated with frequent pulmonary exacerbations which increase the mortality risk. Therefore, most CF patients are chronically colonized with respiratory pathogens, the most common being Pseudomonas aeruginosa. Multidrug-resistant organisms are a major problem in CF patients. It’s been hypothesized that continuous-infusion antipseudomonal beta-lactam therapy in CF maintains serum concentrations above the minimum inhibitory concentration of susceptible strains and is more likely than intermittent infusion to achieve optimal pharmacodynamic targets for some intermediate and resistant strains of P. aeruginosa. The most extensively studied antibiotic for continuous-infusion protocol in CF is ceftazidime, which has been shown to improve lung function (forced expiratory volume in 1 second and forced vital capacity) and to increase pulmonary exacerbation free time. There have been no studies to evaluate the cost effectiveness or impact on quality of life of continuous infusion versus intermittent infusion antibiotic therapy in patients with CF. Our study aims to investigate the effect of continuous-infusion antibiotic therapy on pulmonary function. Methods: Cross sectional study of CF patients who were admitted to our hospital with acute pulmonary exacerbations between 1/1/2010 and 12/31/2016 and received parenteral antibiotics. We investigated the effect of use of continuous versus intermittent infusion of intravenous antibiotics on the pulmonary function (FEV1% predicted). Results: Intermittent infusion protocol was found to have a very small advantage over continuous infusion protocol on pulmonary function; however this difference is not statistically significant (p=0.0049). The longer the duration of antibiotics, the slightly better the pulmonary function at the end of the treatment, but the difference was not significant (p=0.2543). Conclusions: Even though we could not draw meaningful conclusions from our data, we would like bring attention to this subject because it carries an important therapeutic value for CF patients.

Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis

2020 ◽  
Vol 31 (1) ◽  
pp. 112-120
Author(s):  
Layla Diab-Cáceres ◽  
Rosa María Girón-Moreno ◽  
Elena García-Castillo ◽  
Maria Teresa Pastor-Sanz ◽  
Casilda Olveira ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Predictive Value ◽  
Pulmonary Exacerbations

scholarly journals High-Resolution Longitudinal Dynamics of the Cystic Fibrosis Sputum Microbiome and Metabolome through Antibiotic Therapy

mSystems ◽  
2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Ruma Raghuvanshi ◽  
Karla Vasco ◽  
Yoshiki Vázquez-Baeza ◽  
Lingjing Jiang ◽  
James T. Morton ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Pathogenic Bacteria ◽  
Temporal Dynamics ◽  
Alpha Diversity ◽  
Unifrac Distance ◽  
Content Type ◽  
Pulmonary Exacerbations ◽  
Log Ratio ◽  
Clinical Stability

ABSTRACT Microbial diversity in the cystic fibrosis (CF) lung decreases over decades as pathogenic bacteria such as Pseudomonas aeruginosa take over. The dynamics of the CF microbiome and metabolome over shorter time frames, however, remain poorly studied. Here, we analyze paired microbiome and metabolome data from 594 sputum samples collected over 401 days from six adult CF subjects (subject mean = 179 days) through periods of clinical stability and 11 CF pulmonary exacerbations (CFPE). While microbiome profiles were personalized (permutational multivariate analysis of variance [PERMANOVA] r2 = 0.79, P < 0.001), we observed significant intraindividual temporal variation that was highest during clinical stability (linear mixed-effects [LME] model, P = 0.002). This included periods where the microbiomes of different subjects became highly similar (UniFrac distance, <0.05). There was a linear increase in the microbiome alpha-diversity and in the log ratio of anaerobes to pathogens with time (n = 14 days) during the development of a CFPE (LME P = 0.0045 and P = 0.029, respectively). Collectively, comparing samples across disease states showed there was a reduction of these two measures during antibiotic treatment (LME P = 0.0096 and P = 0.014, respectively), but the stability data and CFPE data were not significantly different from each other. Metabolome alpha-diversity was higher during CFPE than during stability (LME P = 0.0085), but no consistent metabolite signatures of CFPE across subjects were identified. Virulence-associated metabolites from P. aeruginosa were temporally dynamic but were not associated with any disease state. One subject died during the collection period, enabling a detailed look at changes in the 194 days prior to death. This subject had over 90% Pseudomonas in the microbiome at the beginning of sampling, and that level gradually increased to over 99% prior to death. This study revealed that the CF microbiome and metabolome of some subjects are dynamic through time. Future work is needed to understand what drives these temporal dynamics and if reduction of anaerobes correlate to clinical response to CFPE therapy. IMPORTANCE Subjects with cystic fibrosis battle polymicrobial lung infections throughout their lifetime. Although antibiotic therapy is a principal treatment for CF lung disease, we have little understanding of how antibiotics affect the CF lung microbiome and metabolome and how much the community changes on daily timescales. By analyzing 594 longitudinal CF sputum samples from six adult subjects, we show that the sputum microbiome and metabolome are dynamic. Significant changes occur during times of stability and also through pulmonary exacerbations (CFPEs). Microbiome alpha-diversity increased as a CFPE developed and then decreased during treatment in a manner corresponding to the reduction in the log ratio of anaerobic bacteria to classic pathogens. Levels of metabolites from the pathogen P. aeruginosa were also highly variable through time and were negatively associated with anaerobes. The microbial dynamics observed in this study may have a significant impact on the outcome of antibiotic therapy for CFPEs and overall subject health.

scholarly journals Ten years of viral and non-bacterial serology in adults with cystic fibrosis

2007 ◽  
Vol 136 (1) ◽  
pp. 128-134 ◽  
Author(s):  
I. J. CLIFTON ◽  
J. A. KASTELIK ◽  
D. G. PECKHAM ◽  
A. HALE ◽  
M. DENTON ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Viral Infection ◽  
Inflammatory Markers ◽  
Influenza A ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Chlamydia Psittaci ◽  
Influenza B ◽  
Intravenous Antibiotics ◽  
Pulmonary Exacerbations

SUMMARYViral infections are associated with pulmonary exacerbations in children with cystic fibrosis (CF), but few studies have addressed the frequency in adults. This paper investigates the frequency and impact of viral infections in adults with CF receiving intravenous antibiotics. Pre- and post-treatment spirometry, inflammatory markers and antibody titres against influenza A, influenza B, adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, Chlamydia psittaci, and Coxiella burnetti were analysed over a 10-year period. Non-bacterial infections were identified in 5·1% of 3156 courses of treatment. The annual incidence of admissions per patient associated with viral infection was 4·9%. The presence of viral infection in association with a pulmonary exacerbation did not adversely affect lung function or inflammatory markers in the short term. Adults with CF have a lower incidence of respiratory viral infections associated with pulmonary exacerbations requiring intravenous antibiotics compared to children and infants with CF.

scholarly journals Comparison of surrogate parameters of prognosis (BMI, FEV1 and need of intravenous antibiotic therapy) between CF-patients with and without P. aeruginosa in Frankfurt and Moscow from 1990 to 2015

2021 ◽  
Author(s):  
◽  
Jean-Pascal Marie Dieudonné Varescon
Keyword(s):  
Cystic Fibrosis ◽  
Antibiotic Therapy ◽  
Missing Values ◽  
Age Groups ◽  
Patient Data ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy ◽  
Significant Difference ◽  
Impact On Survival

Background Previous studies have demonstrated that CF (Cystic Fibrosis) prognosis is dependent of three major parameters: FEV1 (Forced Expiratory Pressure in one second), BMI (Body Mass Index) and need of intravenous antibiotic therapy. The CF centres of Frankfurt, Germany, and Moscow, Russia, care for cystic fibrosis patients. We decided to investigate and compare both centers from 1990 to 2015. No comparable study has been published so far. Method German patient data was collected from the national cystic fibrosis database “Muko.web”. Missing values were extracted from the Hospital Information System. Russian patient data were taken directly from the medical records in Moscow. In a descriptive statistical analysis with Bias and R Studio the values were compared. Result A total of 428 patients from Moscow (217 male, 211 female; 348 (81,3%) were P. aeruginosa positive) and 159 patients from Frankfurt (92 male, 67 female; 137 (86,2%) with P. aeruginosa positive) were compared with regard to P. aeruginosa positivity, BMI, FEV1 and need of intravenous antibiotic therapy. CF patients in Moscow stratified by age groups had lower BMI than CF patients in Frankfurt (age 16-18: p=0,003; age 19-22: p=0,004; age 23-29: p<0,001; age 30-35: p<0,001; age 36-66: p=0,024). In a matching pairs analysis including 100 patients from Frankfurt and 100 patients from Moscow for the year 2015 FEV1 was significantly lower in Moscow patients (p<0,001). Conclusion BMI, FEV1 and need of intravenous therapy have significant impact on survival and on quality of life of CF patients. A lower BMI and a lower FEV1 result in a worse survival and determine the prognosis. This study showed a significant difference in prognostic parameters between Frankfurt and Moscow in the crosssectional analysis for the year 2015. A further study should evaluate this difference to show whether this difference will be found over a longer period of time.

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

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