FW: [sharktank] Antibiotic resistance - abstract

January 15, 2004

I am taking the liberty of forwarding this information from another

excellent and technical CF support list, " sharktank. " Dr. Roe is well

known for her work with CF. Hal

[sharktank] Antibiotic resistance - abstract

Am J Respir Med. 2003;2(4):321-32.

Antibiotic treatment of multidrug-resistant organisms in cystic

fibrosis.

Conway SP, Brownlee KG, Denton M, Peckham DG.

Paediatric and Adult Regional Cystic Fibrosis Centres, St ' and

Seacroft University Hospitals, Leeds, UK.

Respiratory tract infection with eventual respiratory failure is the

major cause of morbidity and mortality in cystic fibrosis (CF).

Infective exacerbations need to be treated promptly and effectively

to minimize potentially accelerated attrition of lung function. The

choice of antibiotic depends on in vitro sensitivity patterns.

However, physicians treating patients with CF are increasingly faced

with infection with multidrug-resistant isolates of Pseudomonas

aeruginosa. In addition, innately resistant organisms such as

Burkholderia cepacia complex, Stenotrophomonas maltophilia and

Achromobacter (Alcaligenes) xylosoxidans are becoming more

prevalent. Infection with methicillin-resistant Staphylococcus

aureus (MRSA) is also a problem. These changing patterns probably

result from greater patient longevity and increased antibiotic use

for acute exacerbations and maintenance care.Multidrug-resistant P.

aeruginosa infection may be treated successfully by using two

antibiotics with different mechanisms of action. In practice

antibiotic choices have usually been made on a best-guess basis, but

recent research suggests that more directed therapy can be achieved

through the application of multiple-combination bactericidal testing

(MCBT). Aerosol delivery of tobramycin for inhalation solution

achieves high endobronchial concentrations that may overcome

bacterial resistance as defined by standard laboratory protocols.

Resistance to colistin is rare and this antibiotic should be seen as

a valuable second-line drug to be reserved for multidrug-resistant

P. aeruginosa. The efficacy of new antibiotic groups such as the

macrolides needs to be evaluated.CF units should adopt strict

segregation policies to interrupt person-to-person spread of B.

cepacia complex. Treatment of panresistant strains is difficult and

often arbitrary. Combination antibiotic therapy is recommended,

usually tobramycin and high-dose meropenem and/or ceftazidime, but

the choice of treatment regimen should always be guided by the

clinical response.The clinical significance of S. maltophilia, A.

xylosoxidans and MRSA infection in CF lung disease remains

uncertain. If patients show clinical decline and are chronically

colonized/infected with either of the former two pathogens,

treatment is recommended but efficacy data are lacking. There are

defined microbiological reasons for attempting eradication of MRSA

but there are no proven deleterious effects of this infection on

lung function in patients with CF. Various treatment protocols exist

but none has been subject to a randomized, controlled

trial.Multidrug-resistant microorganisms are an important and

growing issue in the care of patients with CF. Each patient infected

with such strains should be assessed individually and antibiotic

treatment planned according to in vitro sensitivity, patient drug

tolerance, and results of in vitro studies which may direct the

physician to antibiotic combinations most likely to succeed.

PMID: 14719998 [PubMed - in process]

Warning: A free discussion of medical ideas takes place on this list.

All subscribers agree to hold harmless anyone posting to the list who

advocates particular therapies for use with cystic fibrosis. All

subscribers should consult with their medical professional before making

any changes to their own treatment or to that of their dependents.

January 15, 2004

Thank you Hal!

" There are

> defined microbiological reasons for attempting eradication of MRSA

> but there are no proven deleterious effects of this infection on

> lung function in patients with CF. "

Does it says that there is no proven harmful effect on the lung

funtion from MRSA? So may be no lung damage from MRSA?

Thanks,

> I am taking the liberty of forwarding this information from another

> excellent and technical CF support list, " sharktank. " Dr. Roe is

well

> known for her work with CF. Hal

>

> [sharktank] Antibiotic resistance - abstract

>

> Am J Respir Med. 2003;2(4):321-32.

>

> Antibiotic treatment of multidrug-resistant organisms in cystic

> fibrosis.

>

> Conway SP, Brownlee KG, Denton M, Peckham DG.

>

> Paediatric and Adult Regional Cystic Fibrosis Centres, St '

and

> Seacroft University Hospitals, Leeds, UK.

>

> Respiratory tract infection with eventual respiratory failure is

the

> major cause of morbidity and mortality in cystic fibrosis (CF).

> Infective exacerbations need to be treated promptly and effectively

> to minimize potentially accelerated attrition of lung function. The

> choice of antibiotic depends on in vitro sensitivity patterns.

> However, physicians treating patients with CF are increasingly

faced

> with infection with multidrug-resistant isolates of Pseudomonas

> aeruginosa. In addition, innately resistant organisms such as

> Burkholderia cepacia complex, Stenotrophomonas maltophilia and

> Achromobacter (Alcaligenes) xylosoxidans are becoming more

> prevalent. Infection with methicillin-resistant Staphylococcus

> aureus (MRSA) is also a problem. These changing patterns probably

> result from greater patient longevity and increased antibiotic use

> for acute exacerbations and maintenance care.Multidrug-resistant P.

> aeruginosa infection may be treated successfully by using two

> antibiotics with different mechanisms of action. In practice

> antibiotic choices have usually been made on a best-guess basis,

but

> recent research suggests that more directed therapy can be achieved

> through the application of multiple-combination bactericidal

testing

> (MCBT). Aerosol delivery of tobramycin for inhalation solution

> achieves high endobronchial concentrations that may overcome

> bacterial resistance as defined by standard laboratory protocols.

> Resistance to colistin is rare and this antibiotic should be seen

as

> a valuable second-line drug to be reserved for multidrug-resistant

> P. aeruginosa. The efficacy of new antibiotic groups such as the

> macrolides needs to be evaluated.CF units should adopt strict

> segregation policies to interrupt person-to-person spread of B.

> cepacia complex. Treatment of panresistant strains is difficult and

> often arbitrary. Combination antibiotic therapy is recommended,

> usually tobramycin and high-dose meropenem and/or ceftazidime, but

> the choice of treatment regimen should always be guided by the

> clinical response.The clinical significance of S. maltophilia, A.

> xylosoxidans and MRSA infection in CF lung disease remains

> uncertain. If patients show clinical decline and are chronically

> colonized/infected with either of the former two pathogens,

> treatment is recommended but efficacy data are lacking. There are

> defined microbiological reasons for attempting eradication of MRSA

> but there are no proven deleterious effects of this infection on

> lung function in patients with CF. Various treatment protocols

exist

> but none has been subject to a randomized, controlled

> trial.Multidrug-resistant microorganisms are an important and

> growing issue in the care of patients with CF. Each patient

infected

> with such strains should be assessed individually and antibiotic

> treatment planned according to in vitro sensitivity, patient drug

> tolerance, and results of in vitro studies which may direct the

> physician to antibiotic combinations most likely to succeed.

> PMID: 14719998 [PubMed - in process]

>

> Warning: A free discussion of medical ideas takes place on this

list.

> All subscribers agree to hold harmless anyone posting to the list

who

> advocates particular therapies for use with cystic fibrosis. All

> subscribers should consult with their medical professional before

making

> any changes to their own treatment or to that of their dependents.

>

January 15, 2004

Our CF clinic had the annual CF night last night, and the MRSA question

came up. What the doctors said was the MRSA has shown to cause no more

damage than other staph infections. MRSA is much more dangerous to

post-surgical patients and patients with open wounds.

Elias