Микробиологични аспекти на бронхопулмоналните инфекции при пациенти с муковисцидоза

Aim: To explore the etiological structure of bronchopulmonary infections (BPI) and antimicrobial
susceptibility of the etiological agents in cystic fibrosis (CF) patients.
Patients and methods: During 2006–2011 sputum smear microscopy and culture were accomplished
among 54 patients (23 females and 31 males), aged 5-27 years. Antimicrobial susceptibility testing of
the clinically relevant isolates was performed by the Disk diffusion method.
Results: The most frequent pathogens causing BPI were Pseudomonas aeruginosa (isolated in
31 patients – 57.4%) and Staphylococcus aureus (19 – 35.2%), followed by Candida spp. (16 – 29.6%),
Klebsiella–Enterobacter–Serratia group (6 – 11.1%), Haemophilus influenzae (5 – 9.3%), Burkholderia
cepacia complex (3 – 5.5%) etc. The relative part of patients colonized with P. aeruginosa increased
with age – from 42.1% before 10-year age to 83.3% among 16+ years-old patients (p<0.01). Regarding S. aureus colonization, the following frequencies were established: 42.1% in small children (before 10 years) and 25.0% in adolescent/adult age group (16+ years). The gender distribution showed a significantly higher prevalence of P. aeruginosa infections in girls (73.9% vs. 45.2% among boys – p<0.05), as well as a female predominance of S. aureus infections (43.5% / 29.0%). There were relatively low resistance rates of P. aeruginosa to the following antibiotics: cefepime (6.5%), imipenem (9.7%), meropenem (6.5%), amikacin (12.9%), gentamicin (16.1%), tobramycin (9.7%) and ciprofloxacin (9.7%). A total of 3 of the 19 S. aureus isolates (15.8%) were methicillin-resistant. Conclusion: The current study confirms the global trends of dynamic change of respiratory microbial flora as the CF patient’s age increases – a considerable increase in P. aeruginosa colonization and decrease in S. aureus colonization after 16 years of age. The continuous microbiological monitoring of BPI guarantees their adequate antibiotic therapy, especially in the cases of isolation of intrinsically resistant to aminoglycosides microorganisms such as B. cepacia complex and Stenotrophomonas malthophilia that requires the exclusion of treatment with inhaled tobramycin. Successful eradication of the initial and subsequent BPI in the early years of CF patients improves the quality of life and survival of these individuals.