Multidrug-Resistant Bacteria in Children and Adolescents with Cystic Fibrosis

Abstract

In patients with cystic fibrosis (CF), multidrug-resistant (MDR) bacteria can predispose to exacerbations, limit the effectiveness of antibiotic treatments and promote the progression of lung disease. The aim of this retrospective study was to compare pulmonary exacerbations (Pex), hospitalizations, lung function and nutritional status in a group of children and adolescents with CF colonized by MDR bacteria and in a noncolonized control group. Overall, 7/54 pediatric patients (12.9%) were colonized by MDR bacteria and enrolled (3 with Achromobacter xyloxidans, 3 with Stenotrophomonas maltophilia and 1 with Burkholderia cepacia). The control group included 14 sex- and age-matched CF patients (8/14 colonized by Staphylococcus aureus, 2/14 by Pseudomonas aeruginosa, 2/14 by both microorganisms and 2/14 germ free). At the time of enrollment and 12 months before the first detection of the MDR microorganism, children colonized by MDR bacteria showed lower body mass index (BMI) and lower FEV1/FVC compared to the control group. Over the previous year before the first detection, children colonized with MDR had more Pex compared to control group; those colonized by S. maltophilia experienced the highest number of Pex. In the 12 months following the first detection of MDR bacteria, all seven patients colonized by MDR had at least one Pex and patients colonized by S. maltophilia had the highest number (mean ± SD: 6 ± 2.6 vs. 1.7 ± 2.3). Our study suggests that CF pediatric patients infected by MDR bacteria have lower BMI, more obstructive disease and experience more exacerbations than patients without MDR bacteria. These differences are present even before being infected, suggesting that children and adolescents with more severe disease are predisposed to be colonized by MDR bacteria. S. maltophilia appeared to be the most aggressive pathogen. Further studies and the implementation of antimicrobial stewardship programs are necessary to clarify when and how to treat patients with CF and MDR bacteria in order to avoid the improper use of antibiotics and the development of antibiotic resistance.

Risk factors of lower respiratory tract infection caused by Stenotrophomonas maltophilia: Systematic review and meta-analysis

“…In patients with cystic fibrosis (CF), multidrug resistant (MDR) bacteria can easily worsen the disease, limit the effectiveness of antibiotic treatment, and promote the progression of lung diseases. Fainardi et al found that chronic infection by S. maltophilia was associated with increased risk of Pex and death/transplantation ( 8 ).The study on the risk factors of S. maltophilia lower respiratory tract infection is of great significance for studying the harm of S. maltophilia and taking prevention and control measures. At present, the articles at home and abroad on the risk factors of S. maltophilia infection have some shortcomings, such as small sample size, incomplete risk factor index, and so on ( 9 ).…”

Diagnosis and Therapeutic Strategies Based on Nucleic Acid Aptamers Selected against Pseudomonas aeruginosa: The Challenge of Cystic Fibrosis

“…[37] CF patients are subjected to early and prolonged antibiotic therapy even before being infected with P. aeruginosa; [50,51] this favours the emergence of AMR variants. [52] The frequency of these variants tends to be higher in individuals with CF than in immunocompromised, burned or ulcerated patients, [53] and in different nations, variants resistant to carbapenems (CR) have recently been reported. [54,55] The frequency of MDR strains in these patients has increased from 15.7 % of MDR strains registered in the 2013 report of the CF Foundation (CFF) [56] to 42.4 % by 2022, coupled with 12.7 % of XDR variants.…”

“…CF patients are subjected to early and prolonged antibiotic therapy even before being infected with P. aeruginosa ; [50,51] this favours the emergence of AMR variants [52] . The frequency of these variants tends to be higher in individuals with CF than in immunocompromised, burned or ulcerated patients, [53] and in different nations, variants resistant to carbapenems (CR) have recently been reported [54,55] .…”

Bacteriophage: A new therapeutic player to combat neutrophilic inflammation in chronic airway diseases

“…In 2019, lower respiratory infections globally accounted for over 1.5 million out of 4.95 million estimated deaths associated with antimicrobial resistance, more than any other infectious syndrome ( 56 ). Among individuals with chronic lung diseases, acquisition of AMR/MDR pathogens is associated with increased disease severity ( 57 – 59 ), exacerbations ( 57 , 59 , 60 ), and mortality ( 31 , 61 ). With prevalence of chronic airway conditions increasing by nearly 40% since 1990 ( 62 , 63 ), novel therapeutics to treat AMR lung infections are desperately needed.…”