Abstract
In recent years, advances in diagnosis and treatment have significantly modified the short- and long-term prognosis of cystic fibrosis (CF) patients. However, as in the past, the most important health problem that has significantly reduced the quality of life in CF patients is the progressive deterioration of lung structure and function. In recent years, Achromobacter species have emerged with increasing incidence in the respiratory secretions of CF subjects. The significance of this detection remains debated. In this review article, the characteristics of these pathogens, the importance of their presence in CF patients, and possible antibiotic treatment of treatments for colonization and infection are discussed. Literature analysis shows that Achromobacter species, mainly A. xylosoxidans, are pathogens with intrinsic characteristics that favour persistent lung colonization and several virulence factors and secretion systems that significantly interfere with respiratory cell survival. However, although it seems undebatable that Achromobacterspecies detection is a marker of CF severity, the role of these pathogens as a cause of lung structure and functional deterioration is not definitively established. Nonetheless, there is general agreement about the need for antibiotic therapy to eradicate these pathogens when they are detected in CF patients. Unfortunately, eradication is difficult, and no standard treatment is recommended by scientific societies. New possibilities are potentially offered by some recently developed drugs, such as cefiderocol, but further studies on the dosage, treatment duration and efficacy and safety of this new antibiotic in CF patients of different ages are urgently needed.
Highlights
Ac species are opportunistic pathogens that have been associated with the development of severe infections, such as bacteraemia, endocarditis, pneumonia, and peritonitis [7,8,9,10,11]
Mainly A. xylosoxidans, are pathogens that have only recently been associated with cystic fibrosis (CF)
They have intrinsic characteristics that favour persistent lung colonization and several virulence factors and secretion systems that significantly interfere with respiratory cell survival
Summary
Ac species are gram-negative, lactose nonfermenting, catalase- and oxidase-positive bacilli that are classified as aerobic organisms, they may thrive in anaerobic conditions [12]. Similar to P. aeruginosa, Ac species possess a number of intrinsic characteristics that may explain both their long-term presence in the lung microbiome and their potential ability to damage lung structure and function. Their genome is highly dynamic, and hypermutation can favour adaptation of the pathogen to the lung environment and persistent colonization/infection [16]. Ac species possess a number of protein secretion systems that allow them to deliver lethal toxins into bacterial cells [17, 18] They are resistant to natural antimicrobial peptides contained in airway secretions [19]. They exhibit significant motility and a great ability to adhere to respiratory cells and to form biofilms, all characteristics that are important determinants of persistence, reduced sensitivity to natural defences and antibiotic activity [20, 21]
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