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Growing a Cystic Fibrosis-Relevant Polymicrobial Biofilm to Probe Community Phenotypes
Published on: April 19, 2024
Antimicrobial resistance in cystic fibrosis: A Delphi approach to defining best practices
Edith Zemanick1, Pierre-Régis Burgel2, Giovanni Taccetti3
1Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
Background:
Antimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community.
Methods:
We engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing.
Results:
Consensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results.
Conclusions:
Recommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.
Insights
Antimicrobial susceptibility testing (AST) in cystic fibrosis (CF) may not predict treatment outcomes. Clinical response, not AST, guides CF antimicrobial therapy decisions, suggesting a need to re-evaluate current AST practices.
Area of Science:
- Infectious Diseases
- Pulmonology
- Clinical Microbiology
Background:
- Antimicrobial susceptibility testing (AST) is crucial for managing cystic fibrosis (CF) infections.
- Limited evidence supports AST's ability to predict clinical outcomes in CF patients undergoing antimicrobial treatment.
- Current AST utilization in the CF community warrants careful re-evaluation.
Purpose of the Study:
- To establish expert consensus on the use of respiratory culture results in CF patient management.
- To address key questions regarding test selection, timing, and interpretation of microbiological data.
- To guide clinical decision-making in CF antimicrobial therapy.
Main Methods:
- An international expert panel including pulmonologists, infectious disease specialists, microbiologists, and pharmacists was convened.
- An iterative systematic survey (Delphi method) was employed to reach consensus on critical issues.
- Key questions focused on ordering, timing, and acting upon respiratory culture results in CF.
Main Results:
- Consensus was achieved on numerous aspects of respiratory culture and AST performance in CF.
- Differences in opinion were noted between surveillance cultures and cultures obtained during clinical worsening.
- A significant finding is the reliance on clinical response over AST results for guiding CF treatment decisions.
Conclusions:
- Recommendations are provided for microbiology testing practices in CF patients.
- Priority areas for future research in CF microbiology testing are identified.
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