Impact of Achromobacter spp. isolation on clinical outcomes in children with cystic fibrosis

Abstract

Background: The prevalence of Achromobacter spp. in cystic fibrosis (CF) has increased while its significance remains controversial. Our aim was to investigate the impact of Achromobacter spp. isolation on clinical outcomes in children with CF.Methods: Children with Achromobacter spp. isolation were retrospectively included from the CF database of our center. Control groups of children with CF, who had never been infected by Achromobacter spp., were individually case-matched by age, sex, and Pseudomonas aeruginosa isolation status. Pulmonary function and exacerbation frequency were compared between groups during follow-up.Results: Thirty-seven children had at least one respiratory specimen positive for Achromobacter spp. Achromobacter spp. were chronically isolated from 15 (40.5%) and intermittently from 22 (59.5%) of these 37 children. Although the baseline forced expiratory volume in 1 s (FEV1) z-score was similar between the Achromobacter spp.-infected and -uninfected groups (−0.65 ± 2.22 vs. −0.15 ± 1.30, respectively; p = 0.318), children infected by Achromobacter spp. had a lower FEV1 z-score compared to the control group by the end of the first year (−1.37 ± 2.17 vs. −0.14 ± 1.65, respectively; p = 0.025). In addition, the FEV1 decline in 1 year was significantly greater in the group infected by Achromobacter spp. compared to the uninfected group (−1.18%/year vs. −9.07%/year, respectively; p = 0.043). Furthermore, the cumulative numbers of exacerbations observed in the Achromobacter spp.infected group were higher compared to the control group by the end of the second year (4 [0-17] versus 3 [0-9], respectively; p = 0.001).Conclusions: Achromobacter spp. isolation is associated with more accelerated decline in lung function parameters and frequent exacerbations in children with CF.

Retrospective analysis of Achromobacter species isolated from cystic fibrosis and non-cystic fibrosis patients

“…Literatürde Achromobacter türleri hakkında olgu sunumları haricinde sınırlı sayıda çalışma yer almaktadır. Achromobacter türleri immünokompetan hastalarda daha hafif klinik seyir gösterirken, immün yetmezlikli hastalarda yüksek morbidite ve mortaliteye neden olmakta ve KF hastalarını enfekte etmeleri durumunda akciğer fonksiyonlarında bozulma ve daha sık pulmoner alevlenme saptanmaktadır (5,11,13,18) . KF dışı hastalardaki Achromobacter yayınları, genellikle altta yatan hastalıkları olan hasta gruplarına ve nozokomiyal enfeksiyonlara yöneliktir (1,12,14) .…”

“…Akraba evliliklerinin sıklığı ve ülkemizde kesin tanısı konamadan gastrointestinal sistem ve solunum yolu infeksiyonu nedeniyle kaybedilen çocukların oranının yüksek olduğu göz önüne alınırsa, bu oranın daha yüksek olduğu düşünülebilir. Achromobacter türlerinin KF hastalarını enfekte etmeleri durumunda, akciğer fonksiyonları kötüleşmekte ve daha sık pulmoner alevlenme görülmektedir (5,11,13,18) . Avrupa Antimikrobiyal Duyarlılık Testi Komitesi (EUCAST) Achromobacter türlerinde antibiyotik duyarlılık sonuçlarının değerlendirilebilmesi için ilk kez 2021 yılında üç antibiyotik için (trimetoprim/sülfametoksazol, piperasilin/tazobaktam, meropenem) sınır değerleri tanımlamıştır (6) .…”

“…Achromobacter türleri hakkındaki çalışmalar çoğunlukla küçük seriler veya tek olgu raporları ile sınırlıdır; bu bakteri hakkında daha fazla bilgiye ve araştırmaya ihtiyaç vardır (11,12,14,16,18) . Bu çalışmada, Marmara Üniversitesi Eğitim ve Araştırma Hastanesi'nde son beş yıl içinde izole edilen Achromobacter türleri ile ilgili veriler retrospektif olarak değerlendirilmiş ve hastalara ait demografik özellikler ve antimikrobiyal duyarlılık paternleri irdelenerek literatür bulguları ile karşılaştırılmıştır.…”

Microbial Epidemiology of the Cystic Fibrosis Airways: Past, Present, and Future

“…121 While most studies evaluating Achromobacter have been done in adults, Sunman et al observed similar findings in children with CF with significantly greater ppFEV 1 decline (À9.07 vs. À1.18/year, p ¼ 0.0043) and number of PEx (4 vs. 3, p ¼ 0.0001) in the infected compared to uninfected group, respectively. 122 Similar to P. aeruginosa and Bcc, clonality and potential transmission of Achromobacter between pwCF have been suspected. 114 Currently, there is no evidence to provide guidance on whether eradication may abrogate chronic infection and no standard eradication protocols exist.…”

A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021

“…Work has continued on understanding the complex polymicrobial communities in the CF lung, the impact of treatments on the microbiome and its relationship with disease severity [ 92 , 93 ]. Preliminary studies show that CFTR modulators are associated with modest changes in the CF microbiome [ 94 , 95 ].…”