Original Article
Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years

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Abstract

Background

We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤ 5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources.

Methods

Of 168 CF children aged ≤ 5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy.

Results

Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably.

Conclusions

CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.

Abbreviations

ACFBAL
Australasian Cystic Fibrosis BronchoAlveolar Lavage
BAL
bronchoalveolar lavage
CF
cystic fibrosis
CFU
colony forming units
CI
confidence interval
ERIC
enterobacterial repetitive intergenic consensus
IQR
interquartile range
MLST
multilocus sequence typing
NSW
New South Wales
NZ
New Zealand
OR
odds ratio
PCR
polymerase chain reaction
SA
South Australia
SD
standard deviation
ST
sequence type

Keywords

Pseudomonas aeruginosa
Cystic fibrosis
Infection
Genotyping
Eradication

Cited by (0)

Presented in part at the 25th Annual North American Cystic Fibrosis Conference, Anaheim, California, November 4, 2011.

i

Principal investigator or director.