Pseudomonas aeruginosa

Question

Hello,
I am 50. I was recently diagnosed with cystic fibrosis (ENT and bronchial symptoms with bronchiectasis). During my first check up, mucoid Pseudomonas aeruginosa (10 to the power 5) was found in the bacteriological examination of sputum. Is there any treatment to consider? Is it a resistant bacterium? Am I dangerous for my entourage: babies, children, immunocompromised persons? Thank you for your response.

Answer

Hello,
It is not surprising that Pseudomonas aeruginosa was found in your sputum because it is the most frequent bacterium in the bronchi and sinuses of adult patients with CF, found in 70 - 80% of the cases. You have probably been referred to a specialised CF centre where your doctor will explain you all the possibilities for CF care. The most important treatment is daily physiotherapy allowing a daily bronchial toilet.
More specific treatment of Pseudomonas aeruginosa calls upon antibiotic treatments, but there are few effective antibiotics on this bacterium which are available in the form of tablets. However, it does not mean that your bacteria are resistant to antibiotics. Information on possible resistances to antibiotics is given by antibiogram, i.e. sensitivity tests to antibiotics carried out in laboratory on your sputum. Your doctor will be able to inform you about these results.
Methods of antibiotic treatments can be different according to the circumstances:
1) Initially, one can ask if it is possible "to eradicate" Pseudomonas aeruginosa from your bronchi. That is often possible when it has not been present for a very long time. There is no definitive consensus on the type of antibiotic treatment to use. Nevertheless, if clinical status is correct, many propose a treatment by nebulised antibiotics (tobramycin or colomycin) for a few weeks, possibly associated with a treatment by oral route of ciprofloxacine. If clinical status has worsened, or as a first option for some specialists, the antibiotic treatment consists of intravenous infusions of 2 antibiotics during 15 days (for example ceftazidime and tobramycin). Sputum analysis after treatment will make it possible to know if bronchial colonisation with Pseudomonas persists. If it is the case, one will talk of "chronic" bronchial colonisation.
2) In the event of chronic bronchial colonisation with Pseudomonas, maintenance treatments are recommended with nebulised antibiotics. The 2 main antibiotics prescribed by the nebulised route are tobramycin (nebulisation of 300 mg in the morning and in the evening in 28 days cycles one month out of 2) or colomycin (on average 2 million units in the morning and in the evening for adults). Moreover treatment by azithromycin is recommended: it is an antibiotic used in the form of tablets, which, at low doses, is likely to decrease pulmonary inflammation and virulence factors of Pseudomonas.
3) Within the framework of this chronic bronchial colonisation with Pseudomonas, if clinical exacerbation occurs (with tiredness, increase in cough or respiratory embarrassment, dirtier and more abundant sputum), an IV antibiotic course is indicated. Selected antibiotics are adapted to the results of antibiogram and one usually prescribes 2 antibiotics in association for more effectiveness. This course can be made in the hospital or at home and is planned by the medical team of the CF centre which will be able to answer your questions about its modalities. Maintenance treatment of nebulised antibiotics is usually stopped during the IV course.
Bacteria such as Pseudomonas aeruginosa usually do not present a danger for healthy persons. It is however recommended to comply with the hygiene rules, in particular with the frequent washing of hands and their disinfection with alcohol-based hand gel. On the other hand, your Pseudomonas can represent a risk for fragile people, in particular immunocompromised people or premature babies. I hope to have brought you some answers on this bacterium and its treatments. Yours sincerely.
Dr Dominique Hubert

30.11.2010