Antibiotic Resistance in Patients with Cystic Fibrosis: Past, Present, and Future

Area of Science:

• Microbiology
• Pulmonology
• Pharmacology

Background:

• Cystic fibrosis (CF) patients face recurrent antibiotic exposure, leading to challenges in pathogen eradication and the development of antimicrobial resistance (AMR).
• Conventional culture-based susceptibility testing is insufficient for evaluating AMR in the complex lung microenvironment, failing to account for adaptive mechanisms like biofilm formation.
• Antibiotic dosing in CF is further complicated by modified pharmacokinetics and poor penetration into lung tissue.

Purpose of the Study:

• To review current knowledge on AMR in CF.
• To provide a concise overview of existing therapeutic strategies for CF pulmonary exacerbations.
• To discuss future directions in antimicrobial stewardship for managing AMR in CF.

Main Methods:

• Literature review of existing knowledge on AMR in CF.
• Analysis of conventional and novel diagnostic approaches for AMR evaluation.
• Discussion of current and future therapeutic strategies and antimicrobial stewardship.

Main Results:

• Existing therapeutic strategies are often inadequate for eradicating pathogens and contribute to AMR development.
• Evaluating AMR is challenging due to limitations in conventional methods and pathogen adaptive mechanisms.
• Novel molecular diagnostic tools like metagenomic sequencing are gaining importance.

Conclusions:

• Effective management of AMR in CF requires targeting underlying resistance mechanisms.
• The development of new antibiotics is slow, necessitating urgent strategies for persistent infections.
• Integrated management and monitoring of antibiotic usage are essential for antimicrobial stewardship in CF.