Pseudomonas acquisition in young patients with cystic fibrosis: pathophysiology, diagnosis, and management.
OBJECTIVE
To summarize the pathophysiology of, risk factors for, and outcomes of early Pseudomonas aeruginosa (Pa) infection in CF; to review the results of trials of early intervention and to describe treatment options for early Pa infection.


RESULTS
Chronic lower airway Pa infection is associated with significant morbidity and mortality among CF patients. However, first acquisition of Pa does not appear to cause an immediate and rapid decline in lung function. Early Pa isolates are generally non-mucoid, antibiotic-sensitive, and present at low density, suggesting a possible "window of opportunity" for early intervention.


CONCLUSIONS
Anti-pseudomonal therapy for early infection results in transient Pa eradication, but re-infection with Pa appears inevitable despite early aggressive treatment. There are no controlled trials demonstrating clinical benefit in young children. There is a critical need for further investigation of the clinical outcomes associated with early intervention, the long-term safety profile, and the optimal drug regimen.
Rosenfeld
Margaret
M
Department of Pediatrics, University of Washington, Seattle, USA.
Ramsey
Bonnie W
BW
Gibson
Ronald L
RL
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans; D007223:Infant; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents