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[Antibiotic therapy of cystic fibrosis in children]
N I Kapranov1, L A Shabalova, N Iu Kashirskaia
1Research Clinical Department of Mucoviscidosis, Medical Genetics Research Centre, Russian Academy of Medical Sciences, Moscow.
Insights
Pseudomonas aeruginosa is a primary pathogen in pediatric cystic fibrosis lung infections, often with Staphylococcus aureus. Meropenem, cefepime, and ciprofloxacin show high effectiveness in treating exacerbations.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Chronic bacterial lung infections are a major complication in children with cystic fibrosis (CF).
- Pseudomonas aeruginosa (P. aeruginosa) is a predominant pathogen, frequently co-infecting with Staphylococcus aureus.
- Understanding antibiotic resistance patterns is crucial for effective CF management.
Purpose of the Study:
- To investigate the prevalence of antibiotic-resistant bacteria in pediatric CF patients.
- To evaluate the susceptibility of P. aeruginosa and common microbial associations to various antibiotics.
- To identify effective antibiotic treatment strategies for pulmonary exacerbations in CF.
Main Methods:
- Bacterial isolates from pediatric CF patients with chronic pulmonary processes were analyzed.
- Antimicrobial susceptibility testing was performed on P. aeruginosa, Staphylococcus aureus, and other identified pathogens.
- Effectiveness of antibiotics including aminoglycosides, ciprofloxacin, polymixin B, ceftazidime, meropenem, and cefepime was assessed.
Main Results:
- Pseudomonas aeruginosa maintains a leading role in chronic broncho-pulmonary infections in pediatric CF patients.
- Antibiotic-resistant strains of Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans were identified in 7.1% of isolates.
- P. aeruginosa strains demonstrated susceptibility to aminoglycosides, ciprofloxacin, and polymixin B, with variable susceptibility to ceftazidime (49.6-57.1%).
- Microbial associations including P. aeruginosa and S. aureus were generally susceptible to ciprofloxacin and aminoglycosides but resistant to ceftazidime.
- Meropenem, cefepime, and ciprofloxacin were found to be highly effective against P. aeruginosa exacerbations.
Conclusions:
- Meropenem, cefepime, and ciprofloxacin are recommended for treating acute broncho-pulmonary exacerbations in pediatric CF patients with chronic P. aeruginosa infections.
- Intravenous antibiotic therapy administered outside the hospital setting is clinically effective, cost-efficient, and psychologically beneficial for CF patients.
- Wider implementation of out-of-hospital intravenous antibiotic use in CF care is advocated.
Abstract:
It is postulated that P. aeruginosa in monoculture or in association with Staphylococcus aureus keeps its leading position in chronic bacterial inflammatory broncho-pulmonary processes in children with cystic fibrosis. Antibiotic resistant strains of Burkholderia cepacia, Stenotrophomonas maltophila, Alcaligenes xylosoxidans were revealed (7.1% of the strains). P. aeruginosa strains were susceptible to aminoglycosides, ciprofloxacin, and polymixin B. Susceptibility of smooth and mucoid forms of P. aeruginosa to ceftazidime stayed at the level of 49.6-57.1%. Such microbial associations as P. aeruginosa sm. + S. aureus, P. aeruginosa sm. + P. aeruginosa muc. + S. aureus were mainly susceptible to ciprofloxacin, aminoglycosides and resistant to ceftasidime. Meropenem, cefepim and ciprofloxacin are highly effective antibiotics for the treatment of broncho-pulmonary processes exacerbations at children with chronic P. aeruginosa cystic fibrosis. Intravenous use of antibiotics out of hospital for the treatment of the children with cystic fibrosis is clinically effective, and is economically and psychologically reasonable. It should be used more widely in medical practice.