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Multidrug-Resistant Bacteria in Children and Adolescents with Cystic Fibrosis
Valentina Fainardi1, Cosimo Neglia1, Maria Muscarà1
1Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Insights
Children with cystic fibrosis (CF) colonized by multidrug-resistant (MDR) bacteria experience more lung exacerbations and have poorer health before infection. Stenotrophomonas maltophilia is identified as a particularly aggressive pathogen in CF patients.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Microbiology
Background:
- Multidrug-resistant (MDR) bacteria in cystic fibrosis (CF) patients can lead to exacerbations, treatment limitations, and disease progression.
- Understanding the impact of MDR colonization on pediatric CF patients is crucial for effective management.
- Previous research indicates a link between bacterial infections and worsened clinical outcomes in CF.
Purpose of the Study:
- To compare pulmonary exacerbations (Pex), hospitalizations, lung function, and nutritional status in pediatric CF patients colonized by MDR bacteria versus a non-colonized control group.
- To identify specific MDR pathogens associated with increased clinical burden in CF.
- To investigate whether pre-existing health status influences susceptibility to MDR colonization.
Main Methods:
- Retrospective study comparing 7 pediatric CF patients colonized by MDR bacteria (Achromobacter xyloxidans, Stenotrophomonas maltophilia, Burkholderia cepacia) with 14 matched controls.
- Data collected included pulmonary exacerbations, hospitalizations, lung function (FEV1/FVC), and body mass index (BMI).
- Analysis focused on clinical parameters in the 12 months preceding and following MDR detection, and compared to controls.
Main Results:
- MDR-colonized CF patients exhibited lower BMI and FEV1/FVC compared to controls, even before MDR detection.
- MDR-colonized patients experienced significantly more pulmonary exacerbations in the year prior to MDR detection.
- Stenotrophomonas maltophilia colonization was associated with the highest number of exacerbations both before and after detection.
Conclusions:
- Pediatric CF patients colonized by MDR bacteria demonstrate poorer nutritional status and lung function, and higher exacerbation rates.
- The findings suggest that children with more severe CF disease may be predisposed to MDR colonization.
- Antimicrobial stewardship is essential to guide treatment decisions for MDR bacteria in CF to prevent resistance.
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.
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