Impact of Pseudomonas and Staphylococcus infection on inflammation and clinical status in young children with cystic fibrosis.
OBJECTIVE
To assess the effects of Pseudomonas aeruginosa and Staphylococcus aureus infection on lower airway inflammation and clinical status in young children with cystic fibrosis (CF).


METHODS
We studied 111 children age < 6 years who had 2 P aeruginosa-positive oropharyngeal cultures within 12 months. We examined bronchoalveolar lavage fluid (BALF) inflammatory markers (ie, cell count, differential, interleukin [IL]-8, IL-6, neutrophil elastase), CF-related bacterial pathogens, exotoxin A serology, and clinical indicators of disease severity.


RESULTS
Young children with CF with both upper and lower airway P aeruginosa infection had higher neutrophil counts, higher IL-8 and free neutrophil elastase levels, increased likelihood of positive exotoxin A titers, and lower Shwachman scores compared with those with positive upper airway cultures only. S aureus was associated with increased lower airway inflammation, and the presence of both P aeruginosa and S aureus had an additive effect on concentrations of lower airway inflammatory markers. BALF markers of inflammation were increased with the number of different bacterial pathogens detected.


CONCLUSIONS
Young children with CF who have upper and lower airway P aeruginosa infection have increased endobronchial inflammation and poorer clinical status compared with those with only upper airway P aeruginosa infection. The independent and additive effects of S aureus on inflammation support the significance of polymicrobial infection in early CF lung disease.
Sagel
Scott D
SD
Department of Pediatrics, The Children's Hospital and University of Colorado Health Sciences Center, Aurora, CO 80045, USA. sagel.scott@tchden.org
Gibson
Ronald L
RL
Emerson
Julia
J
McNamara
Sharon
S
Burns
Jane L
JL
Wagener
Jeffrey S
JS
Ramsey
Bonnie W
BW
D015415:Biomarkers / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D001999:Bronchoscopy; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000503:physiopathology*; D005098:Exotoxins / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D016209:Interleukin-8 / Q000378:metabolism; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000378:metabolism; D008168:Lung / Q000382:microbiology* / Q000503:physiopathology; D008297:Male; D009504:Neutrophils / Q000378:metabolism; D009960:Oropharynx / Q000382:microbiology; D011552:Pseudomonas Infections / Q000175:diagnosis*; D011550:Pseudomonas aeruginosa; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis*; D013211:Staphylococcus aureus
D015415:Biomarkers; D005098:Exotoxins; D016209:Interleukin-8; D019272:Leukocyte Elastase