Highlights
- •Polymicrobial infections common in pediatric pulmonary exacerbations.
- •Most polymicrobial infections treated with antibiotics that cover all bacteria.
- •Prior complete antibiotic coverage predicts subsequent complete coverage.
Abstract
Background
No data exist to guide antibiotic selection among people with CF (PwCF) with respiratory
cultures positive for multiple CF-related bacteria (polymicrobial infections). This
study aimed to describe the number of polymicrobial in-hospital treated pulmonary
exacerbations (PEx), to determine the proportion of polymicrobial PEx where antibiotics
were prescribed with activity against all bacteria detected (termed complete antibiotic
coverage), and to determine clinical and demographic factors associated with complete
antibiotic coverage.
Methods
Retrospective cohort study using the CF Foundation Patient Registry-Pediatric Health
Information System dataset. Children aged 1–21 years with an in-hospital treated PEx
from 2006 to 2019 were eligible for inclusion. Bacterial culture positivity was based
on any positive respiratory culture in the 12 months prior to a study PEx.
Results
A total of 4,923 children contributed 27,669 total PEx of which 20,214 were polymicrobial;
of these, 68% of PEx had complete antibiotic coverage. In regression modeling, a prior
PEx with complete antibiotic coverage for MRSA was associated with a higher likelihood
of having complete antibiotic coverage at a subsequent study PEx (OR (95% CI) 3.48
(2.50, 4.83)).
Conclusions
The majority of children with CF hospitalized for polymicrobial PEx were prescribed
complete antibiotic coverage. Prior PEx treatment with complete antibiotic coverage
predicted complete antibiotic coverage at a future PEx for all bacteria studied. Studies
are needed comparing outcomes of polymicrobial PEx treated with different antibiotic
coverages to optimize PEx antibiotic selection.
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Article info
Publication history
Published online: February 25, 2023
Accepted:
February 4,
2023
Received in revised form:
January 9,
2023
Received:
November 9,
2022
Publication stage
In Press Corrected ProofFootnotes
This work was supported by CFF (COGEN19A0).
Identification
Copyright
© 2023 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
