Douglas T A, Brennan S, Gard S, Berry L, Gangell C, Stick S M, Clements B S, Sly P D
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia Perth, Western Australia.
Eur Respir J. 2009 Feb;33(2):305-11. doi: 10.1183/09031936.00043108. Epub 2008 Nov 14.
When do infants and young children with cystic fibrosis acquire infection with Pseudomonas aeruginosa? Can this be eradicated when first detected? Children <6 yrs of age participated in an annual bronchoalveolar lavage (BAL)-based microbiological surveillance programme in Perth, Australia. When P. aeruginosa was detected, an eradication programme using combination treatment with i.v., oral and nebulised antibiotics was undertaken. Repeat BAL was performed 3 months following treatment, to assess eradication success. P. aeruginosa was detected in 33 (28.4%) children; median (range) age at detection was 30.5 (3.3-71.4) months. P. aeruginosa was mucoid at detection in six (18.2%) out of 33 patients and associated with respiratory symptoms in 16 (48.5%) out of 33 children. In total, 26 children underwent eradication therapy, with P. aeruginosa eradicated in 20 (77%) out of 26 following one eradication cycle and in three (total 88%) additional children following a second cycle. Eradication was associated with a significant decrease in neutrophil elastase and interleukin-1beta in BAL fluid 12 months post eradication. Eradication of Pseudomonas aeruginosa infection is achievable in young children with cystic fibrosis for up to 5 yrs using combination i.v., oral and nebulised antibiotic therapy and is associated with reduced pulmonary inflammation 12 months post eradication.
患有囊性纤维化的婴幼儿何时感染铜绿假单胞菌？首次检测到这种细菌时能否将其根除？6岁以下儿童参与了澳大利亚珀斯一项基于年度支气管肺泡灌洗（BAL）的微生物监测项目。检测到铜绿假单胞菌时，采用静脉注射、口服和雾化抗生素联合治疗的根除方案。治疗3个月后进行重复BAL，以评估根除是否成功。33名（28.4%）儿童检测到铜绿假单胞菌；检测时的中位（范围）年龄为30.5（3.3 - 71.4）个月。33名患者中有6名（18.2%）在检测时铜绿假单胞菌呈黏液样，33名儿童中有16名（48.5%）伴有呼吸道症状。共有26名儿童接受了根除治疗，26名中有20名（77%）在一个根除周期后铜绿假单胞菌被根除，另外3名儿童（共88%）在第二个周期后被根除。根除与根除后12个月BAL液中中性粒细胞弹性蛋白酶和白细胞介素 - 1β显著降低有关。对于患有囊性纤维化的幼儿，使用静脉注射、口服和雾化抗生素联合治疗，在长达5年的时间里可以实现根除铜绿假单胞菌感染，并且根除后12个月肺部炎症会减轻。
