Chronic Stenotrophomonas maltophilia infection and mortality or lung transplantation in cystic fibrosis patients

Waters, Valerie; Atenafu, Eshetu G.; Lu, Annie; Yau, Yvonne; Tullis, Elizabeth; Ratjen, Félix

doi:10.1016/j.jcf.2012.12.006

Cited by 120 publications

(95 citation statements)

References 21 publications

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“…The registry has few patients LTFU and complete data on patient deaths, making this a robust resource for epidemiology studies. Our results showed a protective effect associated with S. maltophilia, which differs from a previous study by WATERS et al [23], who reported that chronic infection with S. maltophilia was associated with increased mortality or lung transplantation. The discrepancy in results may be due to our inability to differentiate between chronic and intermittent infection, which is a limitation of the data source.…”

Section: Discussioncontrasting

confidence: 99%

“…In addition, the prevalence of bacteria such as S. maltophilia and MRSA has increased while the prevalence of BCC is declining. These trends are important to recognise as these data have potential infection control implications and prior literature has shown that infection with these organisms can have a significant negative impact on survival [23,24].…”

Section: Discussionmentioning

confidence: 99%

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A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

et al. 2014

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Previously established predictors of survival may no longer apply in the current era of cystic fibrosis (CF) care. Our objective was to identify risk factors associated with survival in a contemporary CF population.We used the Canadian CF Registry, a population-based cohort, to calculate median age of survival and summarise patient characteristics from 1990 to 2012. Clinical, demographic and geographical factors, and survival were estimated for a contemporary cohort (2000-2012) using Cox proportional hazards models.There were 5787 individuals in the registry between 1990 and 2012. Median survival age increased from 31.9 years (95% CI 28.3-35.2 years) in 1990 to 49.7 years (95% CI 46.1-52.2 years) in the most current 5-year window ending in 2012. Median forced expiratory volume in 1 s improved ( p=0.04) and fewer subjects were malnourished ( p<0.001) over time. Malnourished patients (hazard ratio (HR) 2.1, 95% CI 1.6-2.8), those with multiple exacerbations (HR 4.5, 95% CI 3.2-6.4) and women with CF-related diabetes (HR 1.8, 95% CI 1.2-2.7) were at increased risk of death.Life expectancy in Canadians with CF is increasing. Modifiable risk factors such as malnutrition and pulmonary exacerbations are associated with an increased risk of death. The sex gap in CF survival may be explained by an increased hazard for death in women with CF-related diabetes. @ERSpublications Malnutrition and pulmonary exacerbations increase the risk of death in CF but survival in CF has increased over time

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

et al. 2014

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“…50,51 Stenotrophomonas infections have been associated with poor prognosis for cystic fibrosis treatment. 52 We found that concurrent treatment with antibiotics and probiotics lead to an increase in microbial diversity, albeit a small percentage and not statistically significant. The probiotics themselves did not persist in the ceca or large intestine of antibiotic treated mice, but it did promote the presence of more Firmicutes and Enterobacteriaceae.…”

Section: Discussionmentioning

confidence: 60%

Impact of probiotic supplements on microbiome diversity following antibiotic treatment of mice

2016

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Shifts in microbial populations of the intestinal tract have been associated with a multitude of nutritional, autoimmune, and infectious diseases. The limited diversity following antibiotic treatments creates a window for opportunistic pathogens, diarrhea, and inflammation as the microbiome repopulates. Depending on the antibiotics used, microbial diversity can take weeks to months to recover. To alleviate this loss of diversity in the intestinal microbiota, supplementation with probiotics has become increasingly popular. However, our understanding of the purported health benefits of these probiotic bacteria and their ability to shape the microbiome is significantly lacking. This study examined the impact of probiotics concurrent with antibiotic treatment or during the recovery phase following antibiotic treatment of mice. We found that probiotics did not appear to colonize the intestine themselves or shift the overall diversity of the intestinal microbiota. However, the probiotic supplementation did significantly change the types of bacteria which were present. In particular, during the recovery phase the probiotic caused a suppression of Enterobacteriaceae outgrowth (Shigella and Escherichia) while promoting a blooming of Firmicutes, particularly from the Anaerotruncus genus. These results indicate that probiotics have a significant capacity to remodel the microbiome of an individual recovering from antibiotic therapy.

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“…pulmonary exacerbation, and greater rates of mortality or need for lung transplantation (50)(51)(52)(53)(54)(55). P. aeruginosa, B. cepacia complex, and S. maltophilia are found in the environment and have consequently developed ways of surviving in harsh milieus with exposure to naturally occurring antimicrobials.…”

Section: Ats Seminarsmentioning

confidence: 99%

Antibiotic Management of Lung Infections in Cystic Fibrosis. I. The Microbiome, Methicillin-Resistant Staphylococcus aureus, Gram-Negative Bacteria, and Multiple Infections

et al. 2014

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Despite significant advances in treatment strategies targeting the underlying defect in cystic fibrosis (CF), airway infection remains an important cause of lung disease. In this two-part series, we review recent evidence related to the complexity of CF airway infection, explore data suggesting the relevance of individual microbial species, and discuss current and future treatment options. In Part I, the evidence with respect to the spectrum of bacteria present in the CF airway, known as the lung microbiome is discussed. Subsequently, the current approach to treat methicillin-resistant Staphylococcus aureus, gram-negative bacteria, as well as multiple coinfections is reviewed. Newer molecular techniques have demonstrated that the airway microbiome consists of a large number of microbes, and the balance between microbes, rather than the mere presence of a single species, may be relevant for disease pathophysiology. A better understanding of this complex environment could help define optimal treatment regimens that target pathogens without affecting others. Although relevance of these organisms is unclear, the pathologic consequences of methicillin-resistant S. aureus infection in patients with CF have been recently determined. New strategies for eradication and treatment of both acute and chronic infections are discussed. Pseudomonas aeruginosa plays a prominent role in CF lung disease, but many other nonfermenting gram-negative bacteria are also found in the CF airway. Many new inhaled antibiotics specifically targeting P. aeruginosa have become available with the hope that they will improve the quality of life for patients. Part I concludes with a discussion of how best to treat patients with multiple coinfections.

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Chronic Stenotrophomonas maltophilia infection and mortality or lung transplantation in cystic fibrosis patients

Cited by 120 publications

References 21 publications

A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

A contemporary survival analysis of individuals with cystic fibrosis: a cohort study

Impact of probiotic supplements on microbiome diversity following antibiotic treatment of mice

Antibiotic Management of Lung Infections in Cystic Fibrosis. I. The Microbiome, Methicillin-Resistant Staphylococcus aureus, Gram-Negative Bacteria, and Multiple Infections

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