Mikrobielle Besiedelung bei Mukoviszidose-Patienten an einem Zentrum für Kinder- und Jugendmedizin

Zusammenfassung

Die mikrobielle Besiedelung der Lunge insbesondere mit Pseudomonas aeruginosa und pulmonale Infektionen sind ein wichtiger Faktor für die Morbidität und Mortalität bei CF-Patienten. Die Kenntnis über pulmonale Besiedelungen und Resistenzspektren der Erreger ist daher von großer Bedeutung für eine effektive Betreuung der Patienten. Für diese Arbeit wurden Sputumbefunde aller Patienten, die von 1980–2003 in der Ambulanz der Universitätsklinik und Poliklinik für Kinder und Jugendliche Leipzig betreut wurden, im Hinblick auf Keim- und Resistenzspektrum der Erreger retrospektiv ausgewertet. Es zeigte sich eine Zunahme der Besiedelungen mit Pseudomonas aeruginosa. Der Anteil der Patienten, die mit Staph. aureus oder Hämophilus influenzae besiedelt war, blieb konstant. Wenige Patienten waren mit Burkholderia cepacie, Stenotrophomonas maltophilia, Nocardien oder atypischen Mykobakterien besiedelt. Diese Besiedelungen hatten unterschiedliche klinische Auswirkungen. Bei der Untersuchung der Resistenzspektren zeigte sich bei Pseudomonas aeruginosa eine deutliche Zunahme der gegen Aminoglykoside resistenten Erreger.

Summary

Bacterial colonisation of the respiratory tract especially with Pseudomonas aeruginosa and pulmonal infections are important regarding morbidity and mortality in patients with CF. For effective treatment of the patients knowledge of bacterial colonisation and resistency is necessary. We collected microbiological data of sputum or deep throat swabs of our pediatric CF-patients from 1980 until 2003. We found an increase in colonizations with Pseudomonas aeroginosa meanwhile the amount of patients colonized with Staphylococcus aureus or Haemophilus influenzae remained stable. Rare bacteria e. g. Burkholderia cepacia, Stenotrophomodas maltophilia, Nocardia or atypic mycobacteria were found only in few patients. Colonization with one of those bacteria had different clinical impact. Regarding the resistency of Pseudomonas aeruginosa we found a remarkable increase in bacterial strains resistant against aminoglycosides.

Schlüsselwörter

Mukoviszidose - mikrobielle Besiedelung der Lunge - pulmonale Infektionen

Keywords

Cystic fibrosis - bacterial colonisation of the respiratory tract - pulmonal infections

• Literatur

• 1 Aebi C, Bauernfeind A, Döring G. et al. Mikrobiologie. In: Reinhardt D, Götz M, Kraemer R, Schöni MH. Cystische Fibrose, 1. Aufl. Springer Verlag; 2001: 75-121.
• 2 Armstrong DS, Grimwood K, Carlin JB. et al. Bronchoalveolar lavage or oropharyngeal cultures to identify lower respiratory pathogens in infants with cystic fibrosis. Pediatr Pulmonol 1996; 21: 267-275.
• 3 Burns JL. Emergence of new pathogens in CF: The devil we know or the devil we don´t know?. J Pediatr 2002; 140: 283-284.
• 4 Burns JL, Emerson J, Stapp JR. et al. Microbiology of sputum from patients at cystic fibrosis centers in the United States. Clin Infect Dis 1998; 27: 158-163.
• 5 Canton R, Valdezate S, Vindel A. et al. Antimicrobial sasceptibility profile of molecular typed cystic fibrosis Stenotrophomonas maltophilia isolates and differences with noncystic fibrosis isolates. Pediatr Pulmonol 2003; 35: 99-107.
• 6 Ciofu O, Fussing V, Bagge N. et al. Characterization of paired mucoid/non-mucoid Pseudomonas aeruginosa isolates from Danish cystic fibrosis patients: antibiotic resistance, ß-lactamase activity and riboprinting. J Antimicrobiol Chemoth 2001; 48: 391-396.
• 7 Ciofu O, Jensen T, Pressler T. et al. Meropenem in cystic fibrosis patients infected with resistant Pseudomonas aeruginosa or Burkholderia cepacia and with hypersensitivity to ß-lactam antibiotics. Clin Microbiol Infect 1996; 2: 91-98.
• 8 Cullen AR, Cannon CL, Mark EJ, Colin AA. Mycobacterium abseccus infection in Cystic fibrosis Colonization or infection. Am J Respir Crit Care Med 2000; 161: 641-645.
• 9 Davidson DJ, Dorin JR, Mc Lachlan G. et al. Lung disease in the cystic fibrosis mouse exposed to bacterial pathogens. Nat Genet 1995; 9: 351-357.
• 10 Demko CA, Stern RC, Doershuk CF. Stenotrophomonas maltophilia in cystic fibrosis incidence and prevalence. Pediatr Pulmonol 1998; 25: 304-308.
• 11 Denton M, Rajgopal A, Mooney L. et al. Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis. J Hosp Infect 2003; 55 (Suppl. 03) 180-183.
• 12 Döring G, Conway SP, Heijerman HGM. et al. Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: A European consensus. Eur Respir J 2000; 16: 749-767.
• 13 Emerson J, Rosenfeld M, McNamara S. et al. Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis. Pediatr Pulmonol 2002; 34: 91-100.
• 14 Esther CR, Henry MM, Molina PL, Leigh MW. Nontuberculuos mycobacterial infection in young children with cystic fibrosis. Pediatr Pulmonol 2005; 40: 39-44.
• 15 Farrell PM, Shen G, Splaingard M. et al. Acquisition of Pseudomonas aeruginosa in children with cystic fibrosis. Pediatrics 1997; 100 (Suppl. 05) E2.
• 16 Gilligan PH. Microbiology of airway disease in patients with cystic fibrosis. Clin Microbiol Rev 1991; 4: 35-51.
• 17 Goss CH, Mayer-Hamblett N, Aitken ML. et al. Association between Stenotrophomonas maltophilia and lung function in cystic fibrosis. Thorax 2004; 59: 955-959.
• 18 Goss CH, Otto K, Aitken ML, Rubenfeld GD. Detecting Stenotrophomonas maltophilia does not reduce survival of patients with cystic fibrosis. Am J Respir Crit Care 2002; 166: 356-361.
• 19 Hoyby N. Microbiology of lung infections in cystic fibrosis. Acta paediatr Scand 1982; Suppl 301: 33-54.
• 20 Isles A, Maclusky I, Corey M. et al. Pseudomonas cepacia in cystic fibrosis: An emerging problem. J Pediatr 1984; 104: 206-210.
• 21 Kohn AS, Conrad DA. Recurrent fevers in a five-year-old boy with cystic fibrosis. Pediatr Infect Dis J 2003; 22 (Suppl. 05) 478-479.
• 22 Kosorok MR, Zeng L, West SHE. et al. Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition. Pediatr Pulmonol 2001; 32: 277-287.
• 23 Lumb R, Greville H, Sangster N, Holmes M. Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis 2002; 21 (Suppl. 03) 230-233.
• 24 Marchac V, Equi A, Le Bihan-Benjamin C. et al. Case-control Study of Stenotrophomonas maltophilia acquisition in cystic fibrosis patients. Eur Respir J 2004; 23: 98-102.
• 25 Mendes C, Turner PJ. MYSTIC Study Group (Europe). Unit differences in pathogen occurrence arising from the MYSTIC Program European database 1997–2000. Diagn Microbiol Infect Dis 2001; 41: 191-196.
• 26 Mooney L, Kerr KG, Denton M. Survival of Stenotrophomonas maltophilia following exposure to concentrations of tobramycin used in aerosolized therapy for cystic fibrosis patients. Int J Anti-microb Agents 2001; 17: 63-66.
• 27 Nixon GM, Armstrong DS, Carzino R. et al. Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis. J Pediatr 2001; 138 (Suppl. 05) 699-704.
• 28 Ojeniyi B, Fredrikson B, Hoiby N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol 2001; 29: 177-181.
• 29 Olivier KN, Weber DJ, Wallace RJ. et al. Nontuberculuos mycobacteria I: Multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 2003; 167: 828-834.
• 30 Pablo Y, Asher T. Pathological case of the month. Nocardia asteroides infection in cystic fibrosis. Arch Pediatr Adolesc Med 1994; 148 (Suppl. 02) 209-210.
• 31 Pfaller MA, Jones RN, Biedenbach DJ. Mystic Program Study Group. Antimicrobial resistance trends in medical centers using carbapenems: Report of 1999 and 2000 results from the MYSTIC Program (USA). Diagn Microbiol Infect Dis 1994; 41: 177-182.
• 32 Prober CG, Walson PD, Jones J. Technical Report: Precautions regarding the use of aerolized antibiotics. Pediatrics 2000; 106 (Suppl. 06) E89.
• 33 Ratjen F, Comes G, Paul K. et al. Effect of continuous antistaphylococcal therapy on the rate of P. aeruginosa acquisition in patients with cystic fibrosis. Pediatr Pulmonol 2001; 31: 13-16.
• 34 Rosenfeld M, Gibson RL, McNamara S. et al. Early pulmonary infection, inflammation and clinical outcomes in cystic fibrosis. Pediatr Pulmonol 2001; 32: 356-366.
• 35 Ryan G, Mukhopadhyay S, Singh M. Nebulised anti pseudomonal antibiotics for cystic fibrosis.. Cochrane Database Syst Rev. 2003 Issue 3 CD001021.
• 36 Sattler CA. Stenotrophomonas maltophilia infection in children. Pediatr Infect Dis J. 2000; 19: 877-878.
• 37 Shawar RM, Mac Leod DL, Garber RL. et al. Activities of Tobramycin and six other antibiotics against Pseudomonas aeruginosa isolates from patients with cystic fibrosis. Antimicrob Agents Chemother 1999; 43: 2877-2880.
• 38 Stutman HR, Liebermann JM, Nussbaum E. et al. Antibiotic prophylaxis in infants and young children with cystic fibrosis: A randomized controlled trial. J Pediatr 2002; 140: 299-305.
• 39 Talmaciu I, Varlotta L, Mortensen J, Schidlow DV. Risk factors for emergence of Stenotrophomonas maltophilia in cystic fibrosis. Pediatr Pulmonol 2000; 30: 10-15.
• 40 Tamm M, Eich C, Frei R. et al. Inhalatives Colistin bei zystischer Fibrose. Schweiz Med Wochenschr 2000; 130: 1366-1372.
• 41 Tümmler B, Koopmann U, Grothues D. et al. Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients. J Clin Microbiol 1991; 29 (Suppl. 06) 1265-1267.