TY - JOUR
T1 - Pseudomonas aeruginosa antibiotic resistance in Australian cystic fibrosis centres
AU - Smith, Daniel J.
AU - Ramsay, Kay A.
AU - Yerkovich, Stephanie T.
AU - Reid, David W
AU - Wainwright, Claire E.
AU - Grimwood, Keith
AU - Bell, Scott C.
AU - Kidd, Timothy J.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background and objective: 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. Methods: 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. Results: 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. Conclusion: 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. Multi-antibiotic resistant Pseudomonas aeruginosa (MARPA) are recognized increasingly in cystic fibrosis (CF) patients. Wide variation exists in MARPA prevalence and antibiotic usage between Australian CF centres. MARPA was associated with intravenous antibiotic intensity in children and treating Australian state for both adults and children, but not with worse clinical outcomes. See Editorial, page 205
AB - Background and objective: 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. Methods: 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. Results: 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. Conclusion: 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. Multi-antibiotic resistant Pseudomonas aeruginosa (MARPA) are recognized increasingly in cystic fibrosis (CF) patients. Wide variation exists in MARPA prevalence and antibiotic usage between Australian CF centres. MARPA was associated with intravenous antibiotic intensity in children and treating Australian state for both adults and children, but not with worse clinical outcomes. See Editorial, page 205
KW - antibiotic resistance
KW - cystic fibrosis
KW - epidemiology
KW - Pseudomonas aeruginosa
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=84955276376&partnerID=8YFLogxK
U2 - 10.1111/resp.12714
DO - 10.1111/resp.12714
M3 - Article
C2 - 26711802
AN - SCOPUS:84955276376
VL - 21
SP - 329
EP - 337
JO - Respirology
JF - Respirology
SN - 1323-7799
IS - 2
ER -