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Published ahead of print on December 11, 2003, doi:10.1164/rccm.200309-1306OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 7, April 2004, 811-815

A more recent version of this article appeared on April 1, 2004
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Submitted on September 23, 2003
Accepted on December 9, 2003

Adult Cystic Fibrosis Exacerbations and New Strains of Pseudomonas aeruginosa

Shawn D Aaron1*, Karam Ramotar1, Wendy Ferris2, Katherine Vandemheen3, Raphael Saginur1, Elizabeth Tullis4, David Haase5, Dan Kottachchi3, Melissa St. Denis2, and Francis Chan2

1 Medicine, University of Ottawa, Ottawa, Ontario, Canada, 2 Pediatrics, University of Ottawa, Ottawa, Ontario, Canada, 3 Clinical Epidemiology Unit, The Ottawa Health Research Institute, Ottawa, Ontario, Canada, 4 Medicine, The University of Toronto, Toronto, Ontario, Canada, 5 Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

* To whom correspondence should be addressed. E-mail: saaron{at}ottawahospital.on.ca.

We hypothesized that in adults with cystic fibrosis, the acquisition of a new strain of P. aeruginosa may be associated with a pulmonary exacerbation. Eighty-four patients from 8 centers who were chronically infected with P. aeruginosa were prospectively followed over a 26-month period. Patients had sputum cultures performed every three months while clinically stable and at the time of an exacerbation. Forty patients (48%) had an exacerbation requiring intravenous antibiotics during the study period, and in 36 of these patients their P. aeruginosa isolates were genetically typeable by pulsed-field gel electrophoresis. In 34 of the 36 patients (94%), P. aeruginosa recovered during clinical stability and at exacerbation were of the same genotype. In only 2 patients (6%; 95 percent confidence interval 0 to 18%) was a new P. aeruginosa clone cultured during an exacerbation that had not been cultured during clinical stability. There were no significant differences in antibiotic susceptibilities, measured as mean minimal inhibitory concentrations, for isolates retrieved during clinically stable periods compared to isolates retrieved during exacerbations. We conclude that for the majority of adult cystic fibrosis patients a new pulmonary exacerbation is not caused by acquisition of a new strain of P. aeruginosa.
Key words: cystic fibrosis, Pseudomonas aeruginosa, lung infection




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