title: Randomized controlled trial of biofilm antimicrobial susceptibility testing in cystic fibrosis patients.
abstract: This study aimed to determine whether antimicrobial susceptibility testing of Pseudomonas aeruginosa grown as a biofilm, rather than planktonically, improves efficacy of antibiotic treatment for pulmonary exacerbations. This was a multicenter randomized, double-blind controlled trial of 14 days of intravenous antibiotic treatment for pulmonary exacerbations chosen based on conventional vs. biofilm antimicrobial susceptibility results in CF patients with chronic P. aeruginosa infection. There were 74 exacerbations in 39 patients. A total of 46% (12/26) exacerbations in the conventional group compared to 40% (19/48) exacerbations in the biofilm group achieved a ≥3 log drop in P. aeruginosa sputum density (difference -0.03, 95% CI -0.5 to 0.4, p=0.9). Lung function improvements were similar in both groups. Biofilm antimicrobial susceptibility testing did not lead to improved microbiological or clinical outcomes compared to conventional methods in the treatment of pulmonary exacerbations in CF patients with chronic P. aeruginosa.
authors.affiliation: Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Yvonne.Yau@sickkids.ca.
authors.forename: Yvonne C W
authors.initials: YC
authors.lastname: Yau
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Felix.Ratjen@sickkids.ca.
authors.forename: Felix
authors.initials: F
authors.lastname: Ratjen
authors.affiliation: Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; Keenan Research Centre of Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Electronic address: Tullise@smh.ca.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tullis
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada. Electronic address: PWilcox@providencehealth.bc.ca.
authors.forename: Pearce
authors.initials: P
authors.lastname: Wilcox
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, Hamilton Health Sciences Center, McMaster University, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. Electronic address: freitaga@mcmaster.ca.
authors.forename: Andreas
authors.initials: A
authors.lastname: Freitag
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3N1, Canada. Electronic address: mchilvers@cw.bc.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Chilvers
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Hartmut.Grasemann@sickkids.ca.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Grasemann
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Centre for Understanding and Preventing Infection in Children, Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada. Electronic address: jzlosnik@cfri.ubc.ca.
authors.forename: James
authors.initials: J
authors.lastname: Zlosnik
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Centre for Understanding and Preventing Infection in Children, Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada. Electronic address: dspeert@cfri.ubc.ca.
authors.forename: David
authors.initials: D
authors.lastname: Speert
authors.affiliation: Child Evaluative Health Sciences, Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Mary.Corey@sickkids.ca.
authors.forename: Mary
authors.initials: M
authors.lastname: Corey
authors.affiliation: Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Sanja.Stanojevic@sickkids.ca.
authors.forename: Sanja
authors.initials: S
authors.lastname: Stanojevic
authors.affiliation: Division of Microbiology, Department of Laboratory Medicine, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Electronic address: Matukasl@smh.ca.
authors.forename: Larissa
authors.initials: L
authors.lastname: Matukas
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Ronan.Leahy@olchc.ie.
authors.forename: Timothy Ronan
authors.initials: TR
authors.lastname: Leahy
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: sarah.shih@ucdconnect.ie.
authors.forename: Sarah
authors.initials: S
authors.lastname: Shih
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: Valerie.Waters@sickkids.ca.
authors.forename: Valerie
authors.initials: V
authors.lastname: Waters
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D002170:Canada; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000382:microbiology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000706:statistics & numerical data; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000502:physiology; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000379:methods; D013183:Sputum / Q000187:drug effects / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Biofilm; Pseudomonas aeruginosa; Pulmonary exacerbation