Efficacy of<i>Pseudomonas aeruginosa</i>eradication regimens in bronchiectasis

Vallières, Émilie; Tumelty, K.; Tunney, Michael; Hannah, Rosemary; Hewitt, Oonagh; Elborn, J.S.; Downey, D.G.

doi:10.1183/13993003.00851-2016

Cited by 19 publications

(28 citation statements)

References 8 publications

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“…If we accept now that there is robust evidence that P. aeruginosa drives worse outcomes in bronchiectasis there are a number of clinical implications. First, a limited amount of observational data suggest that it may be possible to prevent P. aeruginosa chronic infection by giving eradication treatment with oral, intravenous and/or inhaled antibiotics in combination [27]. A conditional recommendation in favour of this approach was provided in the 2017 ERS bronchiectasis guidelines [28].…”

Section: Discussionmentioning

confidence: 99%

The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis

et al. 2018

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is responsible for chronic infection in many bronchiectasis patients but it is not known whether it is associated with worse clinical outcomes independent of the underlying severity of disease.This study analysed data from 2596 bronchiectasis patients included from 10 different bronchiectasis clinical centres across Europe and Israel, with a 5-year follow-up period. Prevalence of chronic infection and its independent impact on exacerbations, hospitalisations, quality of life and mortality was assessed.The prevalence of chronic infection was 15.0% (n=389). was associated with a higher mortality in a univariate analysis (hazard ratio (HR) 2.02; 95% (confidence interval) CI 1.53-2.66; p<0.0001) but an independent impact on mortality was not found in a multivariate analysis (HR 0.98; 95% CI 0.70-1.36; p=0.89). was independently associated with increased mortality only in patients with frequent exacerbations (two or more per year) (HR 2.03; 95% CI 1.36-3.03; p=0.001). An independent association with worse quality of life of 7.46 points (95% CI 2.93-12.00; p=0.001) was found in a multivariable linear regression. was therefore found to be independently associated with exacerbation frequency, hospital admissions and worse quality of life. Mortality was increased in patients with particularly in the presence of frequent exacerbations.

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Section: Discussionmentioning

confidence: 99%

The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis

et al. 2018

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“…When the microbiomes of the included patients were examined, it was shown that patients with a Haemophilus-dominated microbiome had fewer exacerbations, while patients with a Pseudomonas-or Veillonella-dominated microbiome profile had an increased frequency of exacerbations overall (in both the active agent-and placebo-treated patients) [54]. Patients with P. aeruginosa infections are known to have poorer clinical outcomes, including more frequent exacerbations, decline in lung function, higher requirement for antibiotic therapy and greater sputum production [12,[55][56][57][58]. In the BLESS study, Pseudomonas-or Haemophilus-dominated microbiomes were associated with significantly reduced lung function compared to other microbiome profiles (forced expiratory volume in 1 s 56.8%, 69.9% and 73.1%, respectively) [54].…”

Section: Does the Microbiome Play A Role In Exacerbations And Affect mentioning

confidence: 99%

The microbiome in bronchiectasis

et al. 2019

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Bronchiectasis is increasing in prevalence worldwide, yet current treatments available are limited to those alleviating symptoms and reducing exacerbations. The pathogenesis of the disease and the inflammatory, infective and molecular drivers of disease progression are not fully understood, making the development of novel treatments challenging. Understanding the role bacteria play in disease progression has been enhanced by the use of next-generation sequencing techniques such as 16S rRNA sequencing. The microbiome has not been extensively studied in bronchiectasis, but existing data show lung bacterial communities dominated by Pseudomonas, Haemophilus and Streptococcus, while exhibiting intraindividual stability and large interindividual variability. Pseudomonas- and Haemophilus-dominated microbiomes have been shown to be linked to severe disease and frequent exacerbations. Studies completed to date are limited in size and do not fully represent all clinically observed disease subtypes. Further research is required to understand the microbiomes role in bronchiectasis disease progression. This review discusses recent developments and future perspectives on the lung microbiome in bronchiectasis.

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“…Four recent studies specifically address the impact of eradication of P. aeruginosa infection. The studies from centres in Spain and the UK ranged from 30 to 64 participants and involved a range of regimens and associated with eradication of~50-60% at~6-12 months after completion of therapy [76][77][78][79] (Table 1). It is however not clear from longitudinal studies how many patients spontaneously clear P. aeruginosa over time.…”

Section: Eradication Treatment In Bronchiectasismentioning

confidence: 99%

“…antibiotics is less clear but also recommended if further treatment is required. [77][78][79] The recently published ERS bronchiectasis guidelines provide three alternative eradication protocols, based on the published uncontrolled studies (Fig. 1).…”

Section: Eradication Treatment In Bronchiectasismentioning

confidence: 99%

“…There are no guidelines to assess efficacy of eradication therapy, although studies of the impact of antibiotics in bronchiectasis have reported pathogen eradication at the end of clinical trials (where eradication was a secondary endpoint), 91 at next clinic review, 79 at 3 and 12 months of follow-up 77 and where no Pseudomonas was cultured in three sputum samples over 6 months after eradication. 78 It would be pragmatic to assess sputum culture (at least once) at the next clinic appointment after antibiotics are completed and to assess regularly in the year following. The Spanish guidelines recommend sputum culture to be performed monthly for the first 3 months after completing initial treatment and every 2 months thereafter for 1 year.…”

Section: How To Monitor If Eradication Has Been Successful In An Indimentioning

confidence: 99%

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Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

2018

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Interest in bronchiectasis has increased over the past two decades, as shown by the establishment of disease-specific registries in several countries, the publication of management guidelines and a growing number of clinical trials to address evidence gaps for treatment decisions. This review considers the evidence for defining and treating pulmonary exacerbations, the approaches for eradication of newly identified airway pathogens and the methods to prevent exacerbations through long-term treatments from a pragmatic practice-based perspective. Areas for future studies are also explored. Watch the video abstract.

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Efficacy ofPseudomonas aeruginosaeradication regimens in bronchiectasis

Cited by 19 publications

References 8 publications

The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis

The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis

The microbiome in bronchiectasis

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

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