Early aggressive eradication therapy for intermittent Pseudomonas aeruginosa airway colonization in cystic fibrosis patients: 15 years experience

J Cyst Fibros. 2008 Nov;7(6):523-30. doi: 10.1016/j.jcf.2008.06.009. Epub 2008 Aug 9.

Abstract

Background: Since 1989, CF-patients intermittently colonized with Pseudomonas aeruginosa have been treated with inhaled colistin and oral ciprofloxacin in the Copenhagen CF-centre. The study evaluates 15 years results of this treatment.

Methods: All isolates of P. aeruginosa from CF-patients intermittently colonized with P. aeruginosa from 1989 to 2003 were identified All anti-P. aeruginosa treatments were evaluated for antibiotics used, treatment duration, pseudomonas-free interval and development of chronic infection. All P. aeruginosa isolates were assessed for resistance and for non-mucoid or mucoid phenotype.

Results: 146 CF-patients were included in the study (1106 patient-years). 99 patients had first ever isolate during the study period. Median observation time 7 years (0.1-14.9). 12 patients developed chronic infection. A Kaplan Meyer plot showed protection from chronic infection in up to 80% of patients for up to 15 years. 613 colistin/ciprofloxacin treatments were given. There was no difference in pseudomonas-free interval comparing 3 weeks (5 months) and 3 months (10.4 months) of colistin and ciprofloxacin, but a significant difference compared to no treatment (1.9 months). Patients developing chronic infection had significantly shorter pseudomonas-free interval after treatment of first ever isolate compared to patients remaining intermittently colonized (p<0.003). Treatment failure (P. aeruginosa-positive culture immediately after ended treatment of first ever isolate) was a strong risk factor for development of chronic infection after 3-4 years, OR 5.8. 1093 pseudomonas-isolates were evaluated (86.6% non-mucoid). No colistin-resistance was found. Ciprofloxacin-resistance was found in 4% of isolates.

Conclusion: Treatment of intermittent P. aeruginosa colonization in CF-patients using colistin and ciprofloxacin can protect up to 80% of patients from development of chronic infection for up to 15 years. A positive culture immediately after treatment of first ever isolate is a strong risk factor for development of chronic infection. We found no colistin-resistance and minimal ciprofloxacin-resistance.

MeSH terms

  • Administration, Inhalation
  • Administration, Oral
  • Adolescent
  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Child
  • Child, Preschool
  • Chronic Disease
  • Ciprofloxacin / administration & dosage
  • Cohort Studies
  • Colistin / administration & dosage
  • Cystic Fibrosis / diagnosis
  • Cystic Fibrosis / microbiology*
  • Cystic Fibrosis / therapy
  • Disease-Free Survival
  • Female
  • Humans
  • Infant
  • Male
  • Pseudomonas Infections / diagnosis
  • Pseudomonas Infections / etiology
  • Pseudomonas Infections / prevention & control*
  • Pseudomonas aeruginosa / isolation & purification*
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / etiology
  • Respiratory Tract Infections / prevention & control*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin
  • Colistin