Abstract
We hypothesized that in CF infants microbiologic surveillance with targeted antibiotic intervention preserves pulmonary function. Our program follows a standardized protocol with microbiologic surveillance performed at every visit by oropharyngeal sampling for culture. Positive cultures are treated based on antibiotic susceptibility regardless of clinical status. First detection of Pseudomonas aeruginosa (PA) is treated with a 6 week course of ciprofloxacin and 6 months of inhaled Colistin. Pulmonary function (PFT) is assessed by raised-volume rapid thoracoabdominal compression (RVRTC) and multi-breath washout (MBW). Nutritional status is monitored by weight for length Z-score (WLZ). Twenty four CF infants have participated since 2008. Mean age at diagnosis was 6.8 weeks, 16 are female. On average, 75% of the cultures per patient were positive. Only 6 of the infants had at least one positive culture for PA. In contrast 75% of the infants had at least one positive culture for S. aureus. By RVRTC parameters only 4 infants had evidence for significant obstruction. However by MBW almost all had evidence for mild ventilatory inhomogeneity (mean LCI 8.5±1.1). No correlation was found between RVRTC and MBW parameters. We did find an inverse correlation between WLZ and LCI (r=0.46). Further, we found no relationship between microbiologic results and PFT parameters. Patients with positive cultures, including those with PA, had comparable PFT results to those not infected. Thus, despite airway colonization with CF pathogens, there was no evidence for significant detrimental changes in lung function. We propose that frequent monitoring and targeted use of antibiotics preserves lung function in infants with CF.
- © 2011 ERS