Antibiotic eradication of P. aeruginosa improves long-term lung function in CF

Antibiotic Eradication Therapy (AET) against Pseudomonas aeruginosa improves lung function trajectory in patients with cystic fibrosis (CF), according to findings from retrospective analysis published in Journal of Cystic Fibrosis.

Previous research has not assessed how long-term CF is affected by AET, the standard of care for premature P. aeruginosa infection, a common pathogen of CF lung disease. P. aeruginosa early infection acts as an important predictor of morbidity and mortality in young children with CF. Researchers sought to evaluate the effect of AET on long-term lung trajectories in pediatric CF patients. The primary endpoint was absolute FEV1 decrease over time.

The researchers conducted a 20-year retrospective study that analyzed data on children with CF seen at 2 hospitals in Toronto, Canada, which were included in the Toronto CF Database from 1998 to 2018. The study group included 205 CF patients ( median age at first infection 9.6 years). [IQR 5.6-14.6] year; 48% girls). The data includes lung function tests, medications and patient microbiology, supplemented by systematic review of health records. Patients enrolled were under 18 years of age at entry with a confirmed CF diagnosis, had lung function measurements for a minimum of 10 years, and were P. aeruginosa– Free for at least 1 year.


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Patient data were analyzed for 4 different time points — ages 10, 15, 20 and 25 years — with patients divided into 3 categories based on their experience with P. aeruginosa at any time. Patients were categorized as: Never (those who had never had at the time) P. aeruginosa infection isolated from a sample of the respiratory tract), eradicated (those with P. aeruginosa infection whose infection has cleared up after treatment with AET), or chronic (those whose P. aeruginosa infection was treated with AET but never cured). Researchers used mixed-effects linear regression models to account for the repeated lung function measurements per patient over time.

The analyzes indicated that FEV1 annual decline in lung function in the eradication group was -1.11% predicted/year (95% CI, -1.18 to -1.04) — a rate of decline significantly less than in the chronic group, in which FEV1 annual decline in lung function was -1.57% predicted/year (95% CI, -1.64 to -1.50) (p <.001). In the Never group, FEV1 annual decline in lung function was − 0.77% per year (95% CI, -0.94 to -0.60%).

Researchers concluded that “successful” P. aeruginosa Eradication therapy is associated with long-term improved lung function, supporting the current standard of care in the management of CF patients.” They added, “AET may not only result in improved microbiological outcomes, but also in clinical outcomes.” Study limitations include its retrospective nature.

Reference

Casaredi IG, Shaw M, Waters V, Seeto R, Blanchard A, Ratjen F. Impact of antibiotic eradication therapy of Pseudomonas aeruginosa on long-term lung function in cystic fibrosis. J cyst fibros. Published online Aug 19, 2022. doi:10.1016/j.jcf.2022.08.007

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