Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years

Timothy J Kidd; Kay A Ramsay; Suzanna Vidmar; John B Carlin; Scott C Bell; Claire E Wainwright; Keith Grimwood; ACFBAL Study Investigators

doi:10.1016/j.jcf.2014.12.007

Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5-years

J Cyst Fibros. 2015 May;14(3):361-9. doi: 10.1016/j.jcf.2014.12.007. Epub 2015 Jan 3.

Authors

Timothy J Kidd¹, Kay A Ramsay², Suzanna Vidmar³, John B Carlin³, Scott C Bell⁴, Claire E Wainwright⁵, Keith Grimwood⁶; ACFBAL Study Investigators

Collaborators

ACFBAL Study Investigators:
Claire E Wainwright⁷, Keith Grimwood⁸, Paul W Francis⁹, Carolyn Dakin¹⁰, Joyce Cheney⁷, Narelle George¹¹, John B Carlin¹², Colin F Robertson¹³, Suzanna Vidmar¹², Marj Moodie¹⁴, Rosemary Carzino¹³, Robert Carter¹⁴, David S Armstrong¹⁵, Peter J Cooper¹⁶, Karen McKay¹⁶, A James Martin¹⁷, Bruce Whitehead, John Hunter¹⁸, Catherine A Byrnes¹⁹, Harm A Tiddens²⁰, Karla Graniel, Krista Gerbrands, Lauren Mott

Affiliations

¹ Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia. Electronic address: t.m.kidd@uq.edu.au.
² Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia.
³ Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.
⁴ Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia.
⁵ Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, QLD 4029, Australia.
⁶ Queensland Children's Medical Research Institute, Royal Children's Hospital, The University of Queensland, Herston, QLD 4029, Australia; Griffith Health Institute, Griffith University and Gold Coast University Hospital, Southport, QLD 4222, Australia.
⁷ Queensland Children's Medical Research Institute, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
⁸ Queensland Children's Medical Research Institute, Brisbane, Australia; Griffith University, Brisbane, Australia.
⁹ Royal Children's Hospital, Brisbane, Australia.
¹⁰ Mater Children's Hospital, Brisbane, Australia.
¹¹ Pathology Queensland, Brisbane, Australia.
¹² Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
¹³ Royal Children's Hospital, Melbourne, Australia.
¹⁴ Deakin University, Melbourne, Australia.
¹⁵ Monash Medical Centre, Melbourne, Australia.
¹⁶ The Children's Hospital at Westmead, Sydney, Australia.
¹⁷ Women's & Children's Hospital, Adelaide, Australia.
¹⁸ Children's Hospital, Newcastle, Australia.
¹⁹ Starship Children's Hospital, Auckland, New Zealand.
²⁰ Erasmus Medical Centre, Rotterdam, the Netherlands.

PMID: 25563522
DOI: 10.1016/j.jcf.2014.12.007

Abstract

Background: We describe Pseudomonas aeruginosa acquisitions in children with cystic fibrosis (CF) aged ≤5-years, eradication treatment efficacy, and genotypic relationships between upper and lower airway isolates and strains from non-CF sources.

Methods: Of 168 CF children aged ≤5-years in a bronchoalveolar lavage (BAL)-directed therapy trial, 155 had detailed microbiological results. Overall, 201/271 (74%) P. aeruginosa isolates from BAL and oropharyngeal cultures were available for genotyping, including those collected before and after eradication therapy.

Results: Eighty-two (53%) subjects acquired P. aeruginosa, of which most were unique strains. Initial eradication success rate was 90%, but 36 (44%) reacquired P. aeruginosa, with genotypic substitutions more common in BAL (12/14) than oropharyngeal (3/11) cultures. Moreover, oropharyngeal cultures did not predict BAL genotypes reliably.

Conclusions: CF children acquire environmental P. aeruginosa strains frequently. However, discordance between BAL and oropharyngeal strains raises questions over upper airway reservoirs and how to best determine eradication in non-expectorating children.

Keywords: Cystic fibrosis; Eradication; Genotyping; Infection; Pseudomonas aeruginosa.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Bronchoalveolar Lavage Fluid / microbiology*
Child, Preschool
Cystic Fibrosis / complications
Cystic Fibrosis / microbiology*
DNA, Bacterial / genetics*
Female
Follow-Up Studies
Genotype
Humans
Infant
Male
Oropharynx / microbiology*
Pseudomonas Infections / complications
Pseudomonas Infections / drug therapy
Pseudomonas Infections / microbiology*
Pseudomonas aeruginosa / genetics*
Pseudomonas aeruginosa / isolation & purification
Retrospective Studies

Substances

Anti-Bacterial Agents
DNA, Bacterial