<i>Staphylococcus aureus</i>in cystic fibrosis: problem bug or an innocent bystander?

Hurley, Margaret M.

doi:10.1183/20734735.014718

Cited by 26 publications

(20 citation statements)

References 31 publications

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“…It is possible this was a direct effect of the PA infection or more likely that children who isolate PA have more significant lung disease which affects growth. The effects of acute and chronic SA infection on the growth of children in CF is not well known but early infection, especially occurring as a co-infection with other organisms, may be associated with severe lung disease which would affect growth [19, 20].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the growth of infants diagnosed with cystic fibrosis by newborn screening

et al. 2019

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Background Newborn screening (NBS) for cystic fibrosis (CF) improves nutritional outcomes. Despite early dietetic intervention some children fail to grow optimally. We report growth from birth to 2 years in a cohort of children diagnosed with CF by NBS and identify the variables that influence future growth. Methods One hundred forty-four children were diagnosed with CF by the West Midlands Regional NBS laboratory between November 2007 and October 2014. All anthropometric measurements and microbiology results from the first 2 years were collated as was demographic and CF screening data. Classification modelling was used to identify the key variables in determining future growth. Results Complete data were available on 129 children. 113 (88%) were pancreatic insufficient (PI) and 16 (12%) pancreatic sufficient (PS). Mean birth weight (z score) was 3.17 kg (− 0.32). There was no significant difference in birth weight (z score) between PI and PS babies: 3.15 kg (− 0.36) vs 3.28 kg (− 0.05); p = 0.33. By the first clinic visit the difference was significant: 3.42 kg (− 1.39) vs 4.60 kg (− 0.48); p < 0.0001. Weight and height remained lower in PI infants in the first year of life. In the first 2 years of life, 18 (14%) infants failed to regain their birth weight z score. The median time to achieve a weight z score of − 2, − 1 and 0 was 18, 33 and 65 weeks respectively. The median times to reach the same z scores for height were 30, 51 and 90 weeks. Birth weight z score, change in weight z score from birth to first clinic, faecal elastase, isolation of Pseudomonas aeruginosa, isolation of Staphylococcus aureus and sweat chloride were the variables identified by the classification models to predict weight and height in the first and second year of life. Conclusions Babies with CF have a lower birth weight than the healthy population. For those diagnosed with CF by NBS, the weight difference between PI and PS babies was not significantly different at birth but became so by the first clinic visit. The presence of certain factors, most already identifiable at the first clinic visit can be used to identify infant at increased risk of poor growth.

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Section: Discussionmentioning

confidence: 99%

Factors affecting the growth of infants diagnosed with cystic fibrosis by newborn screening

et al. 2019

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“…Historically, it is has been associated predominantly with paediatric pulmonary infection [2], yet the most recent data shows that ~50 % of even the oldest patients are now colonized [3]. The presence of S. aureus in the respiratory tract varies considerably geographically and over time, and although prevalence appears to decrease with age [4] MRSA is most prevalent between 10-30 year olds [3]. Determining the difference between colonization and infection is both important and difficult.…”

Section: Introductionmentioning

confidence: 99%

An ex vivo cystic fibrosis model recapitulates key clinical aspects of chronic Staphylococcus aureus infection

et al. 2021

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Staphylococcus aureus is the most prevalent organism isolated from the airways of people with cystic fibrosis (CF), predominantly early in life. Yet its role in the pathology of lung disease is poorly understood. In mice, and many experiments using cell lines, the bacterium invades cells or interstitium, and forms abscesses. This is at odds with the limited available clinical data: interstitial bacteria are rare in CF biopsies and abscesses are highly unusual. Bacteria instead appear to localize in mucus plugs in the lumens of bronchioles. We show that, in an established ex vivo model of CF infection comprising porcine bronchiolar tissue and synthetic mucus, S. aureus demonstrates clinically significant characteristics including colonization of the airway lumen, with preferential localization as multicellular aggregates in mucus, initiation of a small colony variant phenotype and increased antibiotic tolerance of tissue-associated aggregates. Tissue invasion and abscesses were not observed. Our results may inform ongoing debates relating to clinical responses to S. aureus in people with CF.

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“…This could be a false-positive result or misinterpretation of a “coloniser” as an “infection”. This is because S. aureus is part of the normal flora found on the skin and mucous membranous area of the nose, mouth and throat, and is commonly encountered in daily living [11]. False-positive cultures of environmental organisms and other contaminants is not uncommon [12].…”

Section: Discussionmentioning

confidence: 99%