Differences in prevalence and treatment of Pseudomonas aeruginosa in cystic fibrosis centres in Denmark, Norway and Sweden.
BACKGROUND
Chronic Pseudomonas aeruginosa (PA) infection causes increased morbidity and mortality in cystic fibrosis (CF). This study aimed to answer the following questions: Does the prevalence of chronic infection with PA differ between the CF centres in Scandinavia? Which differences exist concerning segregation and treatment of PA?


METHODS
989 patients (86%) from all eight CF-centres in Scandinavia were included. Demographic and clinical data, including PA colonisation status based on cultures and serology, were recorded at inclusion. The patients were followed prospectively for 1 year, recording number of days with anti-PA antibiotic treatment.


RESULTS
In all pancreatic insufficient (PI) patients (n=890) the prevalence of chronic PA infection at each centre ranged from 25.8% to 48.9%, but were not significantly different. In PI patients <19 years the prevalence was 14.5% in Copenhagen compared to 30.9% in the Swedish centres pooled (p=0.001). In intermittently colonised PI patients <19 years the median number of days per year on anti-PA antibiotics was almost 6 times higher in Copenhagen (mean 86 (110), median 61 days) compared to the Swedish centres pooled (mean 27 (52), median 11 days) (p=0.037). The pulmonary function was similar.


CONCLUSIONS
It is possible to maintain a very low prevalence of chronic PA infection in CF patients <19 years. We speculate that this was most likely due to a very intensive treatment of intermittently colonised patients with inhaled anti-PA antibiotics over prolonged periods of time in some centres. Since lung function was similar in centres with less intensive use of inhaled antibiotics, studies comparing different treatment modalities and other parts of CF care are needed to define the best clinical practice, including how to use antibiotics in the most rational way.
Knudsen
Per Kristian
PK
National Center for Cystic Fibrosis, Ullevaal University Hospital, Oslo, Norway. pekn@uus.no
Olesen
Hanne V
HV
Høiby
Niels
N
Johannesson
Marie
M
Karpati
Ferenc
F
Laerum
Birger N
BN
Meyer
Peter
P
Pressler
Tacjana
T
Lindblad
Anders
A
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003718:Denmark / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D013183:Sputum / Q000382:microbiology; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents