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Published ahead of print on September 11, 2003, doi:10.1164/rccm.200306-731OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1471-1475

A more recent version of this article appeared on December 15, 2003
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Submitted on June 4, 2003
Accepted on August 22, 2003

Inflammatory and Microbiologic Markers in Induced Sputum following IV Antibiotics in Cystic Fibrosis

Claudia L Ordonez1*, Noreen R Henig2, Nicole Mayer-Hamblett3, Frank J Accurso4, Jane L Burns3, James F Chmiel5, Cori L Daines6, Ronald L Gibson3, Sharon McNamara3, George Z Retsch-Bogart7, Pamela L Zeitlin8, and Moira L Aitken9

1 Medicine, Harvard Medical School, Children's Hospital, Boston, MA, USA, 2 Medicine, Stanford University School of Medicine, Stanford, CA, USA, 3 Pediatrics, University of Washington, Seattle, WA, USA, 4 Pediatrics, University of Colorado School of Medicine, Denver, CO, USA, 5 Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA, 6 Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, 7 Pediatrics, University of North Carolina, Chapel Hill, NC, USA, 8 Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 9 Medicine, University of Washington, Seattle, WA, USA

* To whom correspondence should be addressed. E-mail: claudia.ordonez{at}tch.harvard.edu.

Induced sputum has been used to study airway inflammation. We sought to determine whether markers of infection and inflammation in induced sputum were a useful and safe outcome measure in cystic fibrosis. We hypothesized that bacterial density and inflammatory content of induced sputum would decrease after antibiotic therapy. Induced sputum was assayed for bacterial density, cell count and differential and inflammatory markers before and after intravenous antibiotics. Fifty-five of 72 subjects enrolled (mean age ± standard deviation 18.2 ± 7.9 years) completed the study. FEV1 increased by an average 0.3 ± 0.3 L (10.4 ± 8.7% predicted FEV1), p<0.0001; density of P. aeruginosa and S. aureus decreased by 2.4 ± 3.1 log10 CFU/g (p<0.0005) and 4.0 ± 2.3 log10 CFU/mL (p<0.0001), respectively; neutrophil count decreased by 0.4 ± 0.6 log10 cells/mL (p<0.0001), interleukin-8 concentration by 0.5 ± 1.3 log10 pg/mL (p<0.05), and neutrophil elastase by 0.4 ± 0.7 log10 µg/mL (p<0.005). Seven of 127 (6%) sputum induction procedures had a decrease in FEV1 >= 20%. We conclude that markers in induced sputum may be useful non-invasive outcome measures to assess response to therapies in cystic fibrosis studies.
Key words: cystic fibrosis, induced sputum, inflammatory markers, bacterial density




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