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Acquisition and eradication of P. aeruginosa in young children with cystic fibrosis

¹ Dept of Respiratory Medicine, Princess Margaret Hospital, and ² Division of Clinical Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia.

CORRESPONDENCE: P. D. Sly, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia Perth, Western Australia 6008. Fax: 61 894897706. E-mail: peters{at}ichr.uwa.edu.au

Keywords: Bronchoalveolar lavage, children, cystic fibrosis, eradication, microbiological surveillance, Pseudomonas aeruginosa

Received: March 19, 2008
Accepted October 12, 2008

When do infants and young children with cystic fibrosis acquire infection with Pseudomonas aeruginosa? Can this be eradicated when first detected?

Children <6 yrs of age participated in an annual bronchoalveolar lavage (BAL)-based microbiological surveillance programme in Perth, Australia. When P. aeruginosa was detected, an eradication programme using combination treatment with i.v., oral and nebulised antibiotics was undertaken. Repeat BAL was performed 3 months following treatment, to assess eradication success.

P. aeruginosa was detected in 33 (28.4%) children; median (range) age at detection was 30.5 (3.3–71.4) months. P. aeruginosa was mucoid at detection in six (18.2%) out of 33 patients and associated with respiratory symptoms in 16 (48.5%) out of 33 children. In total, 26 children underwent eradication therapy, with P. aeruginosa eradicated in 20 (77%) out of 26 following one eradication cycle and in three (total 88%) additional children following a second cycle. Eradication was associated with a significant decrease in neutrophil elastase and interleukin-1β in BAL fluid 12 months post eradication.

Eradication of Pseudomonas aeruginosa infection is achievable in young children with cystic fibrosis for up to 5 yrs using combination i.v., oral and nebulised antibiotic therapy and is associated with reduced pulmonary inflammation 12 months post eradication.

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