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Sputum versus bronchoscopy for diagnosis of Pseudomonas aeruginosa biofilms in cystic fibrosis

Depts of Medicine and Pediatrics, and The Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

CORRESPONDENCE: S.D. Aaron, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 211, Ottawa, Ontario, Canada, K1H 8L6. Fax: 1 6137396266. E-mail: saaron@ottawahospital.on.ca

Keywords: Bronchoscopy, cystic fibrosis, microbiology, Pseudomonas aeruginosa

Received: April 26, 2004
Accepted June 11, 2004

This study was supported by grants from Physician Services Inc., and the Ontario Thoracic Society, Ontario, Canada.

The present authors hypothesised that bronchoscopy with protected specimen brush may sample biofilm-forming bacteria adherent to the airway wall, whereas traditional sputum collection may not.

Pseudomonas aeruginosa obtained from sputum, bronchoalveolar lavage and protected brush, taken from the right upper lung bronchus of 12 adult patients with cystic fibrosis, were compared. Retrieved bacteria were genotyped, and grown in planktonic cultures and as biofilms, and susceptibilities to individual antibiotics and to antibiotic combinations were determined.

Bacterial cultures obtained using bronchoscopy did not yield any new strains of bacteria that were not also found in sputum. A total of 10 patients (83%) had a single strain of P. aeruginosa found using sputum, bronchoalveolar lavage and protected brush techniques, and two patients (17%) had two strains recovered in sputum, but only one strain was recovered using bronchoscopic techniques. Susceptibility to single antibiotics and to antibiotic combinations were not different between planktonically or biofilm-grown bacteria derived from sputum, as compared to those obtained by bronchoalveolar lavage and protected brush.

In conclusion, sputum collection provides as much information as bronchoscopy for characterising the genotype and antibiotic susceptibility of chronic Pseudomonas aeruginosa infection in patients with stable cystic fibrosis.

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