Edith Zemanick1, Pierre-Régis Burgel2, Giovanni Taccetti3, Alison Holmes4, Felix Ratjen5, Catherine A Byrnes6, Valerie J Waters7, Scott C Bell8, Donald R VanDevanter9, J Stuart Elborn10, Patrick A Flume11. 1. Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States. Electronic address: Edith.Zemanick@childrenscolorado.org. 2. Division of Respiratory Medicine and Adult Cystic Fibrosis Center, Assistance Publique Hôpitaux de Paris and University Paris Descartes, Paris, France; ERN-Lung cystic fibrosis network. Electronic address: pierre-regis.burgel@aphp.fr. 3. Cystic Fibrosis Center, Department of Pediatrics, University of Florence, Italy. Electronic address: giovanni.taccetti@meyer.it. 4. National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London. United Kingdom. Electronic address: Alison.holmes@imperial.ac.uk. 5. Division of Respiratory Medicine, Department of Pediatrics, Translational Medicine,Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Electronic address: elix.ratjen@sickkids.ca. 6. Department of Paediatrics, University of Auckland & Respiratory Department, Starship Children's Health, Auckland, New Zealand. 7. Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada. Electronic address: Valerie.Waters@sickkids.ca. 8. Department of Thoracic Medicine, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Australia. Electronic address: scott.bell@health.qld.gov.au. 9. Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States. Electronic address: drv15@case.edu. 10. Imperial College and Royal Brompton Hospital, London and Queen's University Belfast, United Kingdom. Electronic address: s.elborn@qub.ac.uk. 11. Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC, United States. Electronic address: flumepa@musc.edu.
Abstract
BACKGROUND: Antimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community. METHODS: We engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing. RESULTS: Consensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results. CONCLUSIONS: Recommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.
BACKGROUND: Antimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community. METHODS: We engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing. RESULTS: Consensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results. CONCLUSIONS: Recommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.
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