Psa Infection Research Articles

Effects of a Pseudomonas aeruginosa eradication policy in a cystic fibrosis clinic

This review is based upon the recent literature regarding eradication of newly acquired infection with Pseudomonas aeruginosa (Psa) in patients with cystic fibrosis (CF) and the economic and other effects of such an early eradication policy in a CF clinic. Various Psa eradication protocols which utilize intravenous or aerosol anti-pseudomonal antibiotics, with or without oral antibiotics, have been reported. The recent ELITE trial reported successful eradication of 90% of Psa in selected Psa antibody negative patients after 28 days of tobramycin for inhalation. Another recent report of a protocol based on intravenous antibiotic use reported elimination of 'first growth' Psa in over 96% of all patients, accompanied by decreased chronic Psa infection, decreased anti-Psa treatment costs and decreased hospitalization costs. The effects of early eradication protocols for Psa have included decreased prevalence of chronic Psa infection, improved patient health and pulmonary function, and decreased hospital and antibiotic costs.

Health-related quality of life in Cystic Fibrosis patients infected with transmissible Pseudomonas aeruginosa strains: cohort study

ObjectivesTo assess the impact on health-related quality of life (HRQoL) in adult cystic fibrosis (CF) patients of chronic infection with the Liverpool Epidemic Strain (LES) of Pseudomonas aeruginosa (Psa).DesignCohort study.ParticipantsAdult CF patients attending a single CF centre.SettingOutpatient clinic.Main outcome measuresHRQoL measures of adult CF patients chronically infected with LES and Psa strains measured by CFQ-UK.ResultsPatients infected by transmissible Psa strains had worse physical functioning, respiratory symptoms, treatment burden, vitality, role, health perception and emotion than those with unique Psa strains (P < 0.01), and significantly poorer physical functioning, respiratory symptoms, treatment burden, body image, weight, role, and emotion than those without any Psa infection (P < 0.05). Furthermore, in a matched cohort of 39 patients, those with LES infection reported significantly worse physical functioning, treatment burden, respiratory symptoms and health perception than those with unique Psa infection (P < 0.02).ConclusionChronic infection with transmissible Psa strains, particularly LES, confers a worse quality of life in adult CF patients. Coupled with the established poorer clinical outcome, this reinforces the need to prevent the spread of such strains in CF community.

Economic effects of an eradication protocol for first appearance of Pseudomonas aeruginosa in cystic fibrosis patients: 1995 vs. 2009

Background Acquisition of Pseudomonas aeruginosa (Psa) and infection with mucoid strains is associated with repeated pulmonary exacerbations which often require intravenous and long-term nebulised antibiotic treatments, repeated hospitalizations and leads to a more precipitous decline in lung function. Anti-Psa antibiotic therapy early in the course of Psa infection in patients with cystic fibrosis (CF) may result in eradication of Psa and prevention or delay of colonization with the organism. From January 1995 to December 2009 our paediatric CF clinic has followed an early eradication protocol for the first appearance of Psa. In this paper we report on the economic effects after 15 years as reflected in hospitalization and antibiotic usage and cost. Methods The Psa-eradication protocol includes 2 weeks of IV piperacillin and tobramycin, followed by oral ciprofloxacin for 3 weeks, and nebulised colistimethate for 6 months. The same protocol is used for newly diagnosed CF patients who grow Psa on their first visit or who grow a mucoid strain, multiresistant strain of Psa or whose Psa co-cultured with Burkholderia cepacia complex, and for patients in whom Psa recurs after initial clearance. Results 195 Psa eradication courses were completed from 1995 to 2009 with an overall Psa clearance rate of 90%. Patients that only cultured a Psa classic (non-mucoid) strain had a clearance rate was 96.5%. The percentage of children chronically infected with Psa has declined from 44% in 1994 to 15% in 2009.Total days spent in hospital for all reasons declined by 43%; chronic Psa hospital days declined by 75%; IV and nebulised anti-Psa antibiotic costs reduced by 44%. Conclusions Results indicate that application of a Pseudomonas eradication protocol as described in this report has economic and resource utilization benefits in addition to clinical benefits.

P98 Accuracy of routine antibiotic susceptibility testing of sputum samples in adult cystic fibrosis (CF) patients colonised with Pseudomonas aeruginosa (Psa)

BackgroundIn CF patients with chronic Psa infection, the role of conventional antibiotic susceptibility testing (antibiotic disc diffusion on sputum subculture morphotypes according to BSAC protocols) is controversial, but many centres...