Impact of Pseudomonas aeruginosa and treatment strategies

Question

Hello

We are the parents of a 2 years old patient with CF, infected by Pseudomonas aeruginosa since he was 6 months old. We would like to know whether it’s the case of many patients on France?

Despite different treatment strategies, our kid can’t get rid of this bacteria; our physician says that it is a chronic colonization and that our kid won’t ever get rid of it. He also says that even if the CF adults chronically colonized are usually less healthy, some of them are doing well.

However, we have met parents whose children could have get rid of it and we heard about “infant pseudomonas”, non-mucoid.

We are looking for some references, statistical data to help to define strategies with our CF center: median age of chronic colonization, correlation with survival, relevance of a first eradication, eradication possibility when the colonization started early in childhood. Are there studies in other countries and where can we found them?

Thank you

Answer

Hello

As your physician surely explained to you, Pseudomonas aeruginosa can first infect and then colonize the airways of the patients with CF. Chronic colonization is defined when this bacteria is still present in the respiratory tract in successive exams for at least 6 months. As for your kid, this chronic colonization can start early in childhood. Eradication of this bacteria is sometimes possible after one or several infections; but is, however, very difficult at the chronic colonization stage.

As reported in the French patient registry, almost 20% of the children of your kid’s age class followed in a French CF center are colonized by this bacteria (www.vaincrelamuco.org/e_upload/pdf/rapport_registre_2008.pdf).


There are also many other statistical data that may be of interest for you in that registry, as, for example, that 50% of patients between 15 and 19 years are colonized with Pseudomonas aeruginosa. The registry does not provide the average age of colonization which would require a longitudinal study over several years.
If you read English, the European (www.ecfs.eu/files/webfm/webfiles/File/ecfs_registry/ECFRreport2007final.pdf) and American (www.cff.org/UploadedFiles/research/ClinicalResearch/Patient-Registry-Report-2009.pdf) registries are also excellent references.
Finally, several studies have been realized, analyzing different eradication treatment regimens. One recent revue describes them (Stuart B. et collaborateurs, Paediatr Respir Rev. 2010 Sep;11(3):177-84).

Sincerely

Dr Harriet Corvol

04.10.2011