Document Detail


Pulmonary exacerbations in cystic fibrosis with negative bacterial cultures.
MedLine Citation:
PMID:  20503282     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary exacerbations are a major cause of morbidity in cystic fibrosis (CF) and likely contribute to lung function decline. Exacerbations are often associated with characteristic airway bacteria [CF related bacteria (CFRB)]. However, some patients do not have CFRB detected by culture during exacerbations.
OBJECTIVES: We sought to determine the proportion of airway cultures negative for CFRB during pulmonary exacerbations, and to characterize patients who were CFRB-negative versus CFRB-positive.
METHODS: We performed a retrospective study of patients with CF admitted for a pulmonary exacerbation. Patients were classified as CFRB-positive or CFRB-negative based on admission airway cultures. Demographics, clinical presentation, lung function, history of chronic Pseudomonas aeruginosa infection and improvement in lung function with treatment were compared between groups.
MAIN RESULTS: There were 672 admissions for exacerbation involving 211 patients over 5 years. Seventeen percent were classified as CFRB-negative. Forty-one percent of bronchoalveolar lavage (BAL), 32% of throat and 10% of sputum samples were CFRB-negative. Among patients capable of expectorating sputum, the CFRB-negative group was younger, less likely to have chronic P. aeruginosa, had higher lung function and body mass index (BMI), and had a lower systemic inflammatory response on admission compared to those with CFRB-positive cultures. The two groups had similar numbers of patients with three or more signs and symptoms of a pulmonary exacerbation (88% vs. 92%). Both groups returned to baseline lung function following treatment.
CONCLUSIONS: A significant number of patients with CF and pulmonary exacerbation did not have typical CFRB detected by culture. Patients without CFRB still had characteristic signs and symptoms of pulmonary exacerbation and responded to treatment. Understanding the causes of illness in these patients may improve the diagnosis and treatment of pulmonary exacerbations in CF.
Authors:
Edith T Zemanick; Brandie D Wagner; J Kirk Harris; Jeffery S Wagener; Frank J Accurso; Scott D Sagel
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  45     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-26     Completed Date:  2010-09-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  569-77     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045, USA. zemanick.edith@tchden.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-Bacterial Agents / therapeutic use*
Azithromycin / therapeutic use
Bronchoalveolar Lavage Fluid / microbiology*
Child
Cystic Fibrosis / drug therapy*,  microbiology*
Disease Progression
Female
Humans
Male
Pseudomonas Infections / drug therapy*
Pseudomonas aeruginosa / drug effects
Retrospective Studies
Sputum / microbiology*
Tobramycin / therapeutic use
Young Adult
Grant Support
ID/Acronym/Agency:
1U01HL081335-01/HL/NHLBI NIH HHS; 1UL1RR025780/RR/NCRR NIH HHS; U01 HL081335-01/HL/NHLBI NIH HHS; UL1 RR025780/RR/NCRR NIH HHS; UL1 RR025780-02/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 32986-56-4/Tobramycin; 83905-01-5/Azithromycin
Comments/Corrections

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