The prevalence of children in the UK Cystic Fibrosis Registry on long term anti-Pseudomonas aeruginosa (PA) inhaled antibiotics who become culture negative for PA and a survey of practice for discontinuing treatment

Abstract

Pseudomonas aeruginosa (PA) is one of the most important respiratory pathogens in cystic fibrosis (CF) as chronic infection has a detrimental effect on morbidity and mortality [ [1] Emerson J. Rosenfeld M. McNamara S. Ramsey B. Gibson R.L. Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis. Pediatr Pulmonol. 2002; 34: 91-100https://doi.org/10.1002/ppul.10127 Crossref PubMed Scopus (804) Google Scholar ]. The Leeds Criteria classify an individual's PA status as never (never isolated PA), free of infection (no PA growth for the previous 12 months but have previously isolated PA), intermittent infection (≤50% of samples in previous 12 months PA culture positive) or chronic infection (>50% of samples in previous 12 months PA culture positive) [ [2] Lee T.W.R. Brownlee K.G. Conway S.P. Denton M. Littlewood J.M. Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients. J Cyst Fibros. 2003; 2: 29-34https://doi.org/10.1016/S1569-1993(02)00141-8 Abstract Full Text Full Text PDF PubMed Scopus (522) Google Scholar ]. It is vital that new isolates of PA are identified and eradication is attempted in a timely manner [ [3] Langton Hewer S.C. Smyth A.R Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis. Cochrane Database Syst Rev. 2009; CD004197https://doi.org/10.1002/14651858.CD004197.pub3 Crossref PubMed Scopus (103) Google Scholar ]. If this is not possible and chronic infection develops, the long-term use of anti-PA nebulised treatment improves lung function and reduces exacerbations [ [4] Smith S. Rowbotham N.J. Inhaled anti-pseudomonal antibiotics for long-term therapy in cystic fibrosis. Cochrane Database Syst Rev. 2022; 11CD001021https://doi.org/10.1002/14651858.CD001021.pub4 Crossref Scopus (5) Google Scholar ]. Most clinical guidelines assume children who have chronic PA infection will continue to isolate PA and therefore stay on anti-PA treatment indefinitely.