title: Pseudomonas aeruginosa antibiotic resistance in Australian cystic fibrosis centres.
abstract: OBJECTIVE
  In cystic fibrosis (CF), chronic Pseudomonas aeruginosa infection is associated with increased morbidity, antibiotic treatments and mortality. By linking Australian CF registry data with a national microbiological data set, we examined the association between where treatment was delivered, its intensity and P. aeruginosa antibiotic resistance.
  
  
  METHODS
  Sputa were collected from paediatric and adult CF patients attending 18 Australian CF centres. P. aeruginosa antibiotic susceptibilities determined by local laboratories were correlated with clinical characteristics, treatment intensity and infection with strains commonly shared among Australian CF patients. Between-centre differences in treatment and antibiotic resistance were also compared.
  
  
  RESULTS
  Large variations in antibiotic usage, maintenance treatment practices and multi-antibiotic resistant P. aeruginosa (MARPA) prevalence exist between Australian CF centres, although the overall proportions of MARPA isolates were similar in paediatric and adult centres (31% vs 35%, P = 0.29). Among paediatric centres, MARPA correlated with intravenous antibiotic usage and the Australian state where treatment was delivered, while azithromycin, reduced lung function and treating state predicted intravenous antibiotic usage. In adult centres, body mass index (BMI) and treating state were associated with MARPA, while intravenous antibiotic use was predicted by gender, BMI, dornase-alpha, azithromycin, lung function and treating state. In adults, P. aeruginosa strains AUST-01 and AUST-02 independently predicted intravenous antibiotic usage.
  
  
  CONCLUSIONS
  Increased treatment intensity in paediatric centres and the Australian state where treatment was received are both associated with greater risk of MARPA, but not worse clinical outcomes.
authors.affiliation: The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Smith
authors.affiliation: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.|The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Kay A
authors.initials: KA
authors.lastname: Ramsay
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Yerkovich
authors.affiliation: The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Reid
authors.affiliation: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.|Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Wainwright
authors.affiliation: Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital, Gold Coast, Queensland, Australia.
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
authors.affiliation: The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.|Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.|The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Bell
authors.affiliation: The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.|Centre for Infection & Immunity, Queen's University Belfast, Belfast, Northern Ireland, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kidd
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001315:Australia; D017963:Azithromycin / Q000627:therapeutic use; D015992:Body Mass Index; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010818:Practice Patterns, Physicians'; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D012042:Registries; D012129:Respiratory Function Tests; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: Pseudomonas aeruginosa; antibiotic resistance; cystic fibrosis; epidemiology; treatment