Changing Epidemiology of the Respiratory Bacteriology of Patients With Cystic Fibrosis.

BACKGROUND Monitoring potential changes in the epidemiology of cystic fibrosis (CF) pathogens furthers our understanding of the potential impact of interventions. METHODS We performed a retrospective analysis using data reported to the Cystic Fibrosis Foundation Patient Registry (CFFPR) from 2006 to 2012 to determine the annual percent changes in the prevalence and incidence of selected CF pathogens. Pathogens included Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), Haemophilus influenzae, Burkholderia cepacia complex, Stenotrophomonas maltophilia, and Achromobacter xylosoxidans. Changes in nontuberculous mycobacteria (NTM) prevalence were assessed from 2010 to 2012, when the CFFPR collected NTM species. RESULTS In 2012, the pathogens of highest prevalence and incidence were MSSA and P aeruginosa, followed by MRSA. The prevalence of A xylosoxidans and B cepacia complex were relatively low. From 2006 to 2012, the annual percent change in overall (as well as in most age strata) prevalence and incidence significantly decreased for P aeruginosa and B cepacia complex, but significantly increased for MRSA. From 2010 to 2012, the annual percent change in overall prevalence of NTM and Mycobaterium avium complex increased. CONCLUSIONS The epidemiology of CF pathogens continues to change. The causes of these observations are most likely multifactorial and include improvements in clinical care and infection prevention and control. Data from this study will be useful to evaluate the impact of new therapies on CF microbiology.

[1]  D. Staab,et al.  Mental health in cystic fibrosis: turning the tide , 2015, Thorax.

[2]  R. Gibson,et al.  US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis: executive summary , 2015, Thorax.

[3]  B. Ramsey,et al.  Pseudomonas aeruginosa in cystic fibrosis patients with G551D-CFTR treated with ivacaftor. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  M. Rosenfeld,et al.  Cystic Fibrosis Foundation pulmonary guideline. pharmacologic approaches to prevention and eradication of initial Pseudomonas aeruginosa infection. , 2014, Annals of the American Thoracic Society.

[5]  J. Adjemian,et al.  Nontuberculous mycobacteria among patients with cystic fibrosis in the United States: screening practices and environmental risk. , 2014, American journal of respiratory and critical care medicine.

[6]  Emily A. Knapp,et al.  Longevity of Patients With Cystic Fibrosis in 2000 to 2010 and Beyond: Survival Analysis of the Cystic Fibrosis Foundation Patient Registry , 2014, Annals of Internal Medicine.

[7]  L. Saiman,et al.  Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update , 2014, Infection Control & Hospital Epidemiology.

[8]  M. Jennings,et al.  Eradication strategy for persistent methicillin-resistant Staphylococcus aureus infection in individuals with cystic fibrosis—the PMEP trial: study protocol for a randomized controlled trial , 2014, Trials.

[9]  S. McColley,et al.  Improved patient safety through reduced airway infection rates in a paediatric cystic fibrosis programme after a quality improvement effort to enhance infection prevention and control measures , 2014, BMJ quality & safety.

[10]  L. Saiman,et al.  Antimicrobial susceptibility and molecular typing of MRSA in cystic fibrosis , 2014, Pediatric pulmonology.

[11]  C. Goss,et al.  The Cystic Fibrosis Foundation Patient Registry as a tool for use in quality improvement , 2014, BMJ quality & safety.

[12]  Lee H Harrison,et al.  National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. , 2013, JAMA internal medicine.

[13]  J. Leung,et al.  Nontuberculous mycobacteria: the changing epidemiology and treatment challenges in cystic fibrosis , 2013, Current opinion in pulmonary medicine.

[14]  P. Vandamme,et al.  Burkholderia pseudomultivorans sp. nov., a novel Burkholderia cepacia complex species from human respiratory samples and the rhizosphere. , 2013, Systematic and applied microbiology.

[15]  J. Parkhill,et al.  Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystic fibrosis: a retrospective cohort study , 2013, The Lancet.

[16]  N. Høiby,et al.  Respiratory bacterial infections in cystic fibrosis , 2013, Current opinion in pulmonary medicine.

[17]  C. Goss,et al.  Respiratory outbreak of Mycobacterium abscessus subspecies massiliense in a lung transplant and cystic fibrosis center. , 2012, American journal of respiratory and critical care medicine.

[18]  J. Brooke Stenotrophomonas maltophilia: an Emerging Global Opportunistic Pathogen , 2012, Clinical Microbiology Reviews.

[19]  K. E. Bendstrup,et al.  Marked increase in incidence of Achromobacter xylosoxidans infections caused by sporadic acquisition from the environment. , 2011, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[20]  Umer Khan,et al.  Comparative efficacy and safety of 4 randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis. , 2011, Archives of pediatrics & adolescent medicine.

[21]  C. Goss,et al.  Review: Staphylococcus aureus and MRSA in cystic fibrosis. , 2011, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[22]  E. Kerem,et al.  Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. , 2011, American journal of respiratory and critical care medicine.

[23]  L. LaVange,et al.  Treatment intensity and characteristics of MRSA infection in CF. , 2011, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[24]  R. Thomson Changing Epidemiology of Pulmonary Nontuberculous Mycobacteria Infections , 2010, Emerging infectious diseases.

[25]  P. Dřevínek,et al.  Burkholderia cenocepacia in cystic fibrosis: epidemiology and molecular mechanisms of virulence. , 2010, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[26]  J. Emerson,et al.  Changes in cystic fibrosis sputum microbiology in the United States between 1995 and 2008 , 2010, Pediatric pulmonology.

[27]  J. Lipuma The Changing Microbial Epidemiology in Cystic Fibrosis , 2010, Clinical Microbiology Reviews.

[28]  F. Ratjen,et al.  Treatment of early Pseudomonas aeruginosa infection in patients with cystic fibrosis: the ELITE trial , 2009, Thorax.

[29]  L. Saiman,et al.  Respiratory microbiology of patients with cystic fibrosis in the United States, 1995 to 2005. , 2009, Chest.

[30]  F. Lowy,et al.  Staphylococcus aureus Nasal Colonization Among Pediatric Cystic Fibrosis Patients and Their Household Contacts , 2009, The Pediatric infectious disease journal.

[31]  S. Leonardi,et al.  Emerging pathogens in cystic fibrosis: ten years of follow-up in a cohort of patients , 2009, European Journal of Clinical Microbiology & Infectious Diseases.

[32]  M. Hodson,et al.  Trends in pathogens colonising the respiratory tract of adult patients with cystic fibrosis, 1985-2005. , 2008, Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society.

[33]  S. Boyle-Vavra,et al.  Complex molecular epidemiology of methicillin-resistant staphylococcus aureus isolates from children with cystic fibrosis in the era of epidemic community-associated methicillin-resistant S aureus. , 2008, Chest.

[34]  E. Picard,et al.  Multicenter Cross-Sectional Study of Nontuberculous Mycobacterial Infections among Cystic Fibrosis Patients, Israel , 2008, Emerging infectious diseases.

[35]  P. Berche,et al.  Age-Related Prevalence and Distribution of Nontuberculous Mycobacterial Species among Patients with Cystic Fibrosis , 2005, Journal of Clinical Microbiology.

[36]  H. Mussaffi,et al.  Nontuberculous mycobacteria in cystic fibrosis associated with allergic bronchopulmonary aspergillosis and steroid therapy , 2005, European Respiratory Journal.

[37]  S. Pitlik,et al.  Emergence of Mycobacterium simiae in respiratory specimens , 2005, Scandinavian journal of infectious diseases.

[38]  M. Hodson,et al.  Case-control study of Stenotrophomonas maltophilia acquisition in cystic fibrosis patients , 2004, European Respiratory Journal.

[39]  L. Saiman,et al.  Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-to-Patient Transmission , 2003, Infection Control & Hospital Epidemiology.

[40]  P. Hawkey,et al.  Molecular Epidemiology of Stenotrophomonas maltophilia Isolated from Clinical Specimens from Patients with Cystic Fibrosis and Associated Environmental Samples , 1998, Journal of Clinical Microbiology.

[41]  P. Vandamme,et al.  Short Communication Identification and distribution of Achromobacter species in cystic fibrosis , 2013 .