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Polymicrobial infections and antibiotic treatment patterns for cystic fibrosis pulmonary exacerbations

Anna V Faino1, Lucas R Hoffman2, Ronald L Gibson2

  • 1Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, USA.

Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society
|February 27, 2023
PubMed
Abstract

Insights

Most children with cystic fibrosis (CF) hospitalized for pulmonary exacerbations (PEx) received complete antibiotic coverage. Prior complete antibiotic coverage for MRSA predicted future complete coverage, guiding antibiotic selection for CF PEx.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Pediatric Healthcare

Background:

  • Limited guidance exists for antibiotic selection in cystic fibrosis (CF) patients with polymicrobial respiratory infections.
  • Pulmonary exacerbations (PEx) in CF are often polymicrobial, necessitating effective antibiotic strategies.
  • Understanding antibiotic coverage patterns is crucial for optimizing treatment in CF.

Purpose of the Study:

  • To quantify polymicrobial PEx in hospitalized CF patients.
  • To determine the proportion of PEx receiving complete antibiotic coverage against all detected bacteria.
  • To identify factors associated with complete antibiotic coverage during PEx.

Main Methods:

  • Retrospective cohort study utilizing the CF Foundation Patient Registry-Pediatric Health Information System.
  • Inclusion of children aged 1-21 years with in-hospital treated PEx (2006-2019).
  • Bacterial culture data from the 12 months preceding PEx were analyzed.

Main Results:

  • Over 20,000 polymicrobial PEx were analyzed, with 68% receiving complete antibiotic coverage.
  • Prior PEx with complete antibiotic coverage for MRSA significantly increased the likelihood of complete coverage in subsequent PEx (OR 3.48).
  • The majority of CF patients hospitalized for polymicrobial PEx were prescribed appropriate antibiotic regimens.

Conclusions:

  • Most children with CF experiencing PEx receive broad-spectrum antibiotic coverage.
  • Complete antibiotic coverage in a prior PEx is a strong predictor of complete coverage in future PEx.
  • Further research comparing outcomes of different antibiotic strategies for polymicrobial PEx is warranted.

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