NEW YORK (Reuters Health) - In patients with cystic fibrosis (CF), Pseudomonas aeruginosa infection can be suppressed and possibly eradicated if it is caught early in the nonmucoid stage, study findings suggest. The results also indicate that it may take a decade or more for nonmucoid P. aeruginosa to progress to the more difficult-to-treat mucoid variety.
“Doctors taking care of CF patients have always been taught that it’s sort of a point of no return -- when patients get a Pseudomonas infection, you can’t eradicate it,” Dr. Philip M. Farrell said in a telephone interview with Reuters Health. “Our results indicate that you actually can eradicate nonmucoid Pseudomonas.”
In the February 2 Journal of the American Medical Association, Dr. Farrell and his colleagues at the University of Wisconsin in Madison describe the epidemiology of P. aeruginosa infection and its impact on CF pulmonary morbidity, based on data collected in an ongoing longitudinal study of 56 children with CF who have been followed from birth up to age 16.
Sixteen children (29%) developed nonmucoid P. aeruginosa infection in the first 6 months of life, and the transformation to mucoid P. aeruginosa increased markedly from age 4 to age 16.
However, the “most significant” finding, Dr. Farrell said, is the relatively long transition time (median, 10.9 years) from nonmucoid to mucoid Pseudomonas. Moreover, this transition time could be “slightly extended” with brief/low anti-P aeruginosa antibiotic therapy.
The investigators also observed that worsening cough, chest x-rays, and pulmonary function correlated best with transition from nonmucoid to mucoid Pseudomonas infection.
Summing up, Dr. Farrell noted that “while we’ve known for years that mucoid Pseudomonas is the most serious and resistant to antibiotics, we’ve not known in the past that there is actually a long transition period from when the patients are first infected by the nonmucoid variety of Pseudomonas until they transform into mucoid Pseudomonas.”
The current study “really provides a hopeful message by showing that there is a long window of opportunity to suppress and possibly eradicate early nonmucoid Pseudomonas in CF patients,” he added.
At the same time, this new knowledge challenges the healthcare delivery system and the providers of CF care to “diagnose the patients early, monitor them for Pseudomonas infection, and intervene early on when they have the nonmucoid variety of Pseudomonas,” Dr. Farrell pointed out.
“This is kind of a paradigm shift toward prevention of chronic progressive lung disease in these patients,” he concluded.
Source: JAMA 2005;293;581-588. [ Google search on this article ]
Copyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
