The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Respirology. 2016 Feb;21(2):329-37. doi: 10.1111/resp.12714. Epub 2015 Dec 28.
In cystic fibrosis (CF), chronic Pseudomonas aeruginosa infection is associated with increased morbidity, antibiotic treatments and mortality. By linking Australian CF registry data with a national microbiological data set, we examined the association between where treatment was delivered, its intensity and P. aeruginosa antibiotic resistance.
Sputa were collected from paediatric and adult CF patients attending 18 Australian CF centres. P. aeruginosa antibiotic susceptibilities determined by local laboratories were correlated with clinical characteristics, treatment intensity and infection with strains commonly shared among Australian CF patients. Between-centre differences in treatment and antibiotic resistance were also compared.
Large variations in antibiotic usage, maintenance treatment practices and multi-antibiotic resistant P. aeruginosa (MARPA) prevalence exist between Australian CF centres, although the overall proportions of MARPA isolates were similar in paediatric and adult centres (31% vs 35%, P = 0.29). Among paediatric centres, MARPA correlated with intravenous antibiotic usage and the Australian state where treatment was delivered, while azithromycin, reduced lung function and treating state predicted intravenous antibiotic usage. In adult centres, body mass index (BMI) and treating state were associated with MARPA, while intravenous antibiotic use was predicted by gender, BMI, dornase-alpha, azithromycin, lung function and treating state. In adults, P. aeruginosa strains AUST-01 and AUST-02 independently predicted intravenous antibiotic usage.
Increased treatment intensity in paediatric centres and the Australian state where treatment was received are both associated with greater risk of MARPA, but not worse clinical outcomes.
在囊性纤维化（CF）中，慢性铜绿假单胞菌感染与发病率增加、抗生素治疗和死亡率有关。通过将澳大利亚 CF 登记数据与国家微生物数据集相联系，我们研究了治疗地点、其强度与铜绿假单胞菌抗生素耐药性之间的关联。
从在 18 家澳大利亚 CF 中心就诊的儿科和成年 CF 患者中收集痰液。由当地实验室确定的铜绿假单胞菌抗生素敏感性与临床特征、治疗强度以及在澳大利亚 CF 患者中常见的菌株感染相关联。还比较了各中心之间治疗和抗生素耐药性的差异。
尽管儿科和成年中心的 MARPA 分离株的总体比例相似（31%对 35%，P=0.29），但澳大利亚 CF 中心之间的抗生素使用、维持治疗实践和多抗生素耐药性铜绿假单胞菌（MARPA）流行率存在很大差异。在儿科中心，MARPA 与静脉内抗生素使用和治疗地点所在的澳大利亚州相关，而阿奇霉素、肺功能降低和治疗州预测静脉内抗生素使用。在成年中心，体重指数（BMI）和治疗州与 MARPA 相关，而静脉内抗生素使用由性别、BMI、脱氧核糖核酸酶-α、阿奇霉素、肺功能和治疗州预测。在成人中，AUST-01 和 AUST-02 型铜绿假单胞菌株独立地预测了静脉内抗生素使用。
儿科中心和接受治疗的澳大利亚州的治疗强度增加均与 MARPA 风险增加相关，但与临床结局无关。
