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Original Article|Articles in Press

Polymicrobial infections and antibiotic treatment patterns for cystic fibrosis pulmonary exacerbations

Published:February 25, 2023DOI:https://doi.org/10.1016/j.jcf.2023.02.001

      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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      References

        • Ferkol T.
        • Rosenfeld M.
        • Milla C.E.
        Cystic fibrosis pulmonary exacerbations.
        J Pediatr. 2006; 148: 259-264
        • Goss C.H.
        • Burns J.L.
        Exacerbations in cystic fibrosis: epidemiology and pathogenesis.
        Thorax. 2006; 62: 360-367
        • Waters V.
        • Stanojevic S.
        • Atenafu E.G.
        • Lu A.
        • Yau Y.
        • Tullis E.
        • Ratjen F.
        Effect of pulmonary exacerbations on long-term lung function decline in cystic fibrosis.
        Eur Respir J. 2012; 40: 61-66
        • Britto M.T.
        • Kotagal U.R.
        • Hornung R.W.
        • Atherton H.D.
        • Tsevat J.
        • Wilmott R.W.
        Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis.
        Chest. 2002; 121: 64-72
        • Cogen J.D.
        • Oron A.P.
        • Gibson R.L.
        • Hoffman L.R.
        • Kronman M.P.
        • Ong T.
        • Rosenfeld M.
        Characterization of inpatient Cystic Fibrosis Pulmonary Exacerbations.
        Pediatrics. 2017; 139e20162642
        • Flume P.A.
        • Mogayzel P.J.
        • Robinson K.A.
        • Goss C.H.
        • Rosenblatt R.L.
        • Kuhn R.J.
        • Marshall B.C.
        Cystic Fibrosis Pulmonary Guidelines. Treatment of Pulmonary Exacerbations.
        Am J Respir Crit Care Med. 2009; 180: 802-808
        • Al-Aloul M.
        • Miller H.
        • Alapati S.
        • Stockton P.A.
        • Ledson M.J.
        • Walshaw M.J.
        Renal impairment in cystic fibrosis patients due to repeated intravenous aminoglycoside use.
        Pediatr Pulmonol. 2005; 39: 15-20
        • Garinis A.C.
        • Cross C.P.
        • Srikanth P.
        • Carroll K.
        • Feeney M.P.
        • Keefe D.H.
        • Hunter L.L.
        • Putterman D.B.
        • Cohen D.M.
        • Gold J.A.
        • Steyger P.S.
        The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis.
        J Cyst Fibros. 2007; 16: 401-409
        • Vestergaard M.
        • Paulander W.
        • Marvig R.L.
        • Clasen J.
        • Jochumsen N.
        • Molin S.
        • Jelsbak L.
        • Ingmer H.
        • Folkesson A.
        Antibiotic combination therapy can select for broad-spectrum multidrug resistance in pseudomonas aeruginosa.
        Int J Antimicrob. 2016; 47: 48-55
        • Knapp E.A.
        • Fink A.K.
        • Goss C.H.
        • Sewall A.
        • Ostrenga J.
        • Dowd C.
        • Elbert A.
        • Petren K.M.
        • Marshall B.C.
        The cystic fibrosis foundation patient registry: design and methods of a national observational disease registry.
        Ann Am Thorac Soc. 2016; 13: 1173-1179
      1. Pediatric health information systems database, Children's Hospital Association, Lenexa, KS, [Online]. Available: https://www.childrenshospitals.org/Programs-and-Services/Data-Analytics-and-Research/Pediatric-Analytic-Solutions/Pediatric-Health-Information-System.

        • Cogen J.D.
        • Hall M.
        • Loeffler D.R.
        • Gove N.
        • Onchiri F.
        • Sawicki G.S.
        • Fink A.K.
        Linkage of the cystic fibrosis foundation patient registry with the pediatric health information system database.
        Pediatr Pulmonol. 2019; 54: 721-728
        • Cogen J.D.
        • Faino A.V.
        • Onchiri F.
        • Hall M.
        • Fink A.K.
        Evaluation of hospitalization data for the CFFPR-PHIS linked data set.
        Pediatr Pulmonol. 2019; : 1-3
        • Cogen J.D.
        • Faino A.V.
        • Onchiri F.
        • Hoffman L.R.
        • Kronman M.P.
        • Nelson M.
        • Nichols D.P.
        • Rosenfeld M.
        • VanDevanter D.R.
        • Gibson R.L.
        Association of inhaled antibiotics in addition to standard IV therapy and outcomes of pediatric inpatient pulmonary exacerbations.
        Ann Am Thorac Soc. 17. 2020: 1590-1598
        • Gilbert D.N.
        The Sanford guide to antimicrobial therapy 2011.
        Antimicrob Therapy. 2011; : 4-62
        • Chmiel J.F.
        • Aksamit T.R.
        • Chotirmall S.H.
        • Dasenbrook E.C.
        • Elborn J.S.
        • LiPuma J.J.
        • Ranganathan S.C.
        • Waters V.J.
        • Ratjen F.A.
        Antibiotic management of lung infections in cystic fibrosis. I. The microbiome, methicillin-resistant staphylococcus aureus, gran-negative bacteria, and multiple infection.
        Ann Am Thrac Soc. 2014; 11: 1120-1129
        • Courter J.D.
        • Parker S.K.
        • Thurm C.
        • Kronman M.P.
        • Weissman S.J.
        • Shah S.S.
        • Hersh A.L.
        • Brogan T.V.
        • Patel S.J.
        • Smith M.J.
        • Lee B.R.
        • Newland J.G.
        • Gerber J.S.
        Accuracy of administrative data for antimicrobial administration in hospitalized children.
        J Pediatric Infect Dis Soc. 2018; 7: 261-263
        • Rosenfeld M.
        • Emerson J.
        • Accurso F.
        • Armstrong D.
        • Castile R.
        • Grimwood K.
        • Hiatt P.
        • McCoy K.
        • McNamara S.
        • Ramsey B.
        • Wagener J.
        Diagnostic accuracy of oropharyngeal cultures in.
        Pediatr Pulmonol. 1999; 28: 321-328
        • Ronchetti K.
        • Tame J.-.D.
        • Paisey C.
        • Thia L.P.
        • Doull I.
        • Howe R.
        • Mahenthiralingam E.
        • Forton J.T.
        The CF-Sputum Induction Trial (CF-SpIT) to assess lower airway bacterial sampling in young children with cystic fibrosis: a prospective internally controlled interventional trial.
        Lancet Respiratory Med. 2018; 6: 461-471
        • Armstrong D.S.
        • Grimwood K.
        • Carlin J.B.
        • Carzino R.
        • Olinsky A.
        • Phelan P.D.
        Bronchoalveolar lavage of oropharyngeal cultures to identify lower respiratory pathogens in infants with cystic fibrosis.
        Pediatr Pulmonol. 1996; 21: 267-275
        • Ramsey B.W.
        • Wentz K.R.
        • Smith A.L.
        • Richardson M.
        • Williams-Warren J.
        • Hedges D.L.
        • Gibson R.
        • Redding G.J.
        • Lent K.
        • Harris K.
        Predictive value of oropharyngeal cultures for identifying lower airway bacteria in cystic fibrosis patients.
        Am J Respir Crit Care Med. 1991; 144: 331-337
        • Cogen J.D.
        • Hall M.
        • Faino A.V.
        • Ambroggio L.
        • Blaschke A.J.
        • Brogan T.V.
        • Cotter J.M.
        • Gibson R.L.
        • Grijalva C.G.
        • Hersh A.L.
        • Lipsett S.C.
        • Shah S.S.
        • Shapiro D.J.
        • Neuman M.I.
        • Gerber J.S.
        Antibiotics and outcomes of CF pulmonary exacerbations in children infected with MRSA and Pseudomonas aeruginosa.
        J Cystic Fibrosis. 2022; https://doi.org/10.1016/j.jcf.2022.08.001