Timothy J Kidd1, Kay A Ramsay2, Suzanna Vidmar3, John B Carlin3, Scott C Bell4, Claire E Wainwright5, Keith Grimwood6. 1. Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia. Electronic address: t.m.kidd@uq.edu.au. 2. Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia. 3. Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia. 4. Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia. 5. Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, QLD 4029, Australia. 6. Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Griffith Health Institute, Griffith University and Gold Coast University Hospital, Southport, QLD 4222, Australia.
Abstract
BACKGROUND: We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources. METHODS: Of 168 CF children aged ≤5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy. RESULTS: Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably. CONCLUSIONS: CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.
RCT Entities:
BACKGROUND: We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources. METHODS: Of 168 CF children aged ≤5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy. RESULTS: Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably. CONCLUSIONS: CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.
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