Bronchopulmonary infection–colonization patterns in Spanish cystic fibrosis patients: Results from a national multicenter study

Caballero, Juan de Dios; Campo, Rosa del; Royuela, Ana; Solé, Amparó; Máiz, Luís; Olveira, Casilda; Quintana‐Gallego, Esther; Gracia, Javier de; Cobo, M.; Pedrosa, Elia Gómez G. de la; Oliver, Antonio; Cortell, Isidoro; Asensio, Òscar; García, Gloria; Martínez, María Teresa; Cols, María; Salcedo, Antonio; Baranda, F.; Girón, Rosa; Quintana, E.C.; Delgado, Isabel; Miguel, María Ángeles de; García, María Fernández; Oliva, Concepción; Prados, Mónica Cuervo; Barrio, María Isabel; Pastor, María Dolores; Álvarez, Antonio; Escribano, Amparo; Castillo, Silvia; Figuerola, Joan; Togores, Bernat; López, Carla; Tato, Marta; Suárez, L.

doi:10.1016/j.jcf.2015.09.004

Cited by 22 publications

(16 citation statements)

References 21 publications

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“…SXT is the antibiotic of choice for treating S. maltophilia infections, although in recent years, increasing rates of resistance, ranging from 16% to 45%, were reported, especially in CF patients [9,35,36]. Considering available clinical breakpoints, our results confirmed SXT is the most active compound against all the strains tested.…”

Section: Discussionsupporting

confidence: 70%

“…We found that CF strains were significantly more resistant to piperacillin-tazobactam than non-CF strains (90% versus 53.3%, respectively). This finding might be the consequence of the airways' concomitant colonization/infection by both S. maltophilia and P. aeruginosa observed in CF patients [35,40,41]. Consequently, the higher use of this antipseudomonal beta-lactam/beta-lactamase inhibitor combination in CF patients might have exerted a positive antibiotic pressure associated with higher levels of resistance.…”

Section: Discussionmentioning

confidence: 95%

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Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

et al. 2020

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The intrinsic antibiotic resistance of Stenotrophomonas maltophilia, along with its ability to form biofilm both on abiotic surfaces and host tissues, dramatically affects the efficacy of the antibiotic therapy. In this work, 85 S. maltophilia strains isolated in several hospital of central Italy and from several clinical settings were evaluated for their genetic relatedness (by pulsed-field gel electrophoresis, PFGE), biofilm formation (by microtiter plate assay), and planktonic antibiotic resistance (by Kirby–Bauer disk diffusion technique). The S. maltophilia population showed a high genetic heterogeneity: 64 different PFGE types were identified, equally distributed in cystic fibrosis (CF) and non-CF strains, and some consisted of multiple strains. Most of the strains (88.2%) were able to form biofilm, although non-CF strains were significantly more efficient than CF strains. CF strains produced lower biofilm amounts than non-CF strains, both those from respiratory tracts and blood. Non-CF PFGE types 3 and 27 consisted of strong-producers only. Cotrimoxazole and levofloxacin were the most effective antibiotics, being active respectively against 81.2% and 72.9% of strains. CF strains were significantly more resistant to piperacillin/tazobactam compared to non-CF strains (90% versus 53.3%), regardless of sample type. Among respiratory strains, cotrimoxazole was more active against non-CF than CF strains (susceptibility rates: 86.7% versus 75%). The multidrug resistant phenotype was significantly more prevalent in CF than non-CF strains (90% versus 66.7%). Overall, the multidrug-resistance level was negatively associated with efficiency in biofilm formation. Our results showed, for the first time, that in S. maltophilia both classical planktonic drug resistance and the ability of biofilm formation might favor its dissemination in the hospital setting. Biofilm formation might in fact act as a survival mechanism for susceptible bacteria, suggesting that clinical isolates should be routinely assayed for biofilm formation in diagnostic laboratories.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 95%

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

et al. 2020

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“…Cystic fibrosis (CF) patients are regularly colonized by opportunistic microorganisms. In adult patients, Pseudomonas aeruginosa is the main pathogen, but in recent years, other nonfermenting bacteria from different genera, such as Stenotrophomonas, Burkholderia, Achromobacter, Ralstonia, and Pandoraea, are increasingly being isolated [1][2][3]. This could be potentially due to the aggressive antimicrobial therapy used against P. aeruginosa, to the apparition of new techniques for the bacterial identification and improvement in life expectancy for people with CF [4].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial susceptibility of non-fermenting Gram-negative pathogens isolated from cystic fibrosis patients

Díez-Aguilar

Ekkelenkamp

Morosini

et al. 2019

International Journal of Antimicrobial Agents

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Non-fermenting Gram negative bacteria are increasingly being cultured in respiratory samples from people with cystic fibrosis (CF). This study aimed to determine the susceptibility of clinical CF respiratory isolates from distinct geographical regions to a range of antimicrobials. A total of 286 isolates (106 Stenotrophomonas maltophilia, 100 Burkholderia spp., 59 Achromobacter spp., 12 Pandoraea spp. and 9 Ralstonia spp.) from The Netherlands, Northern Ireland, Spain, USA and Australia were tested. The MIC, MIC and susceptibility categorization were determined. Cotrimoxazole was the most active compound for all the microorganisms (MIC=0.12-4 mg/L, MIC=1-16 mg/L). For S. maltophilia, 47% and 62% of isolates were susceptible to cotrimoxazole according to CLSI and EUCAST breakpoints, respectively. Ceftazidime presented a lower level of susceptibility (35%, MIC=32 mg/L, MIC=256 mg/L). Tobramycin and colistin MIC were >128 mg/L and >16 mg/L, respectively. Regarding Burkholderia isolates, 72%, 56% and 44% were susceptible to cotrimoxazole, ceftazidime and meropenem, respectively. For both ceftazidime and meropenem, the MIC and MIC values were within the intermediate or resistant category. The most active antibiotics for A. xylosoxidans were cotrimoxazole (MIC=2, MIC=8 mg/L) and imipenem (MIC=2, MIC=8 mg/L). Cotrimoxazole, imipenem, and ciprofloxacin were active against the 12 Pandoraea species (MIC= 0.12-4 mg/L, MIC= 1-8 mg/L). Ciprofloxacin (MIC=4 mg/L) and cotrimoxazole (MIC=1 mg/L) were the only active antibiotics for Ralstonia spp. There were no statistically significant differences in susceptibility rates between countries. Non-fermenting Gram-negative bacteria other than P. aeruginosa are potential pathogens in CF and cotrimoxazole has demonstrated to be the most active compound against them.

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“…Biofilms of P. aeruginosa are particularly relevant in chronic pulmonary infections in CF patients, where eradication is very difficult. About 54% of CF patients under the age of 18 years are colonized by this microorganism, while the percentage rises to 80% in adults (9).…”

Section: Discussionmentioning

confidence: 99%

Use of Calgary and Microfluidic BioFlux Systems To Test the Activity of Fosfomycin and Tobramycin Alone and in Combination against Cystic Fibrosis Pseudomonas aeruginosa Biofilms

Díez-Aguilar

Morosini

Köksal

et al. 2018

Antimicrob Agents Chemother

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is a major cause of morbidity and mortality in chronically infected cystic fibrosis patients. Novel biofilm models which reliably predict the therapeutic success of antimicrobial therapies against biofilm bacteria should be implemented. The activity of fosfomycin, tobramycin, and the fosfomycin-tobramycin combination against 6 susceptible strains isolated from respiratory samples from cystic fibrosis patients was tested by using two biofilm models: a closed system (Calgary device) and an open model based on microfluidics (BioFlux). All but one of the isolates formed biofilms. The fosfomycin and tobramycin minimal biofilm inhibitory concentrations (MBIC) were 1,024 to>1,024 μg/ml and 8 to 32 μg/ml, respectively. According to fractional inhibitory concentration analysis, the combination behaved synergistically against all the isolates except the ATCC 27853 strain. The dynamic formation of the biofilm was also studied with the BioFlux system, and the MIC and MBIC of each antibiotic were tested. For the combination, the lowest tobramycin concentration that was synergistic with fosfomycin was used. The captured images were analyzed by measuring the intensity of the colored pixels, which was proportional to the biofilm biomass. A statistically significant difference was found when the intensity of the inoculum was compared with the intensity of the microchannel in which the MBIC of tobramycin, fosfomycin, or their combination was used ( < 0.01) but not when the MIC was applied ( > 0.01). Fosfomycin-tobramycin was demonstrated to be synergistic against cystic fibrosis strains in the biofilm models when both the Calgary and the microfluidic BioFlux systems were tested. These results support the clinical use of this combination.

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Bronchopulmonary infection–colonization patterns in Spanish cystic fibrosis patients: Results from a national multicenter study

Abstract: The representative subset of the Spanish CF-population which has been clinically, demographically and microbiologically characterized will serve as a reference for future CF studies in Spain.

Cited by 22 publications

References 21 publications

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

Clonal Diversity, Biofilm Formation, and Antimicrobial Resistance among Stenotrophomonas maltophilia Strains from Cystic Fibrosis and Non-Cystic Fibrosis Patients

Antimicrobial susceptibility of non-fermenting Gram-negative pathogens isolated from cystic fibrosis patients

Use of Calgary and Microfluidic BioFlux Systems To Test the Activity of Fosfomycin and Tobramycin Alone and in Combination against Cystic Fibrosis Pseudomonas aeruginosa Biofilms

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