TY - JOUR
T1 - Antibiotic management of lung infections in cystic fibrosis
T2 - II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi
AU - Chmiel, James F.
AU - Aksamit, Timothy R.
AU - Chotirmall, Sanjay H.
AU - Dasenbrook, Elliott C.
AU - Stuart Elborn, J.
AU - LiPuma, John J.
AU - Ranganathan, Sarath C.
AU - Waters, Valerie J.
AU - Ratjen, Felix A.
N1 - Publisher Copyright:
Copyright © 2014 by the American Thoracic Society
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Airway infections are a key component of cystic fibrosis (CF) lung disease. Whereas the approach to common pathogens such as Pseudomonas aeruginosa is guided by a significant body of evidence, other infections often pose a considerable challenge to treating physicians. In Part I of this series on the antibiotic management of difficult lung infections, we discussed bacterial organisms including methicillin-resistant Staphylococcus aureus, gram-negative bacterial infections, and treatment of multiple bacterial pathogens. Here, we summarize the approach to infections with nontuberculous mycobacteria, anaerobic bacteria, and fungi. Nontuberculous mycobacteria can significantly impact the course of lung disease in patients with CF, but differentiation between colonization and infection is difficult clinically as coinfection with other micro-organisms is common. Treatment consists of different classes of antibiotics, varies in intensity, and is best guided by a team of specialized clinicians and microbiologists. The ability of anaerobic bacteria to contribute to CF lung disease is less clear, even though clinical relevance has been reported in individual patients. Anaerobes detected in CF sputum are often resistant to multiple drugs, and treatment has not yet been shown to positively affect patient outcome. Fungi have gained significant interest as potential CF pathogens. Although the role of Candida is largely unclear, there is mounting evidence that Scedosporium species and Aspergillus fumigatus , beyond the classical presentation of allergic bronchopulmonary aspergillosis, can be relevant in patients with CF and treatment should be considered. At present, however there remains limited information on how best to select patients who could benefit from antifungal therapy.
AB - Airway infections are a key component of cystic fibrosis (CF) lung disease. Whereas the approach to common pathogens such as Pseudomonas aeruginosa is guided by a significant body of evidence, other infections often pose a considerable challenge to treating physicians. In Part I of this series on the antibiotic management of difficult lung infections, we discussed bacterial organisms including methicillin-resistant Staphylococcus aureus, gram-negative bacterial infections, and treatment of multiple bacterial pathogens. Here, we summarize the approach to infections with nontuberculous mycobacteria, anaerobic bacteria, and fungi. Nontuberculous mycobacteria can significantly impact the course of lung disease in patients with CF, but differentiation between colonization and infection is difficult clinically as coinfection with other micro-organisms is common. Treatment consists of different classes of antibiotics, varies in intensity, and is best guided by a team of specialized clinicians and microbiologists. The ability of anaerobic bacteria to contribute to CF lung disease is less clear, even though clinical relevance has been reported in individual patients. Anaerobes detected in CF sputum are often resistant to multiple drugs, and treatment has not yet been shown to positively affect patient outcome. Fungi have gained significant interest as potential CF pathogens. Although the role of Candida is largely unclear, there is mounting evidence that Scedosporium species and Aspergillus fumigatus , beyond the classical presentation of allergic bronchopulmonary aspergillosis, can be relevant in patients with CF and treatment should be considered. At present, however there remains limited information on how best to select patients who could benefit from antifungal therapy.
KW - Anaerobic bacteria
KW - Aspergillus fumigatus
KW - Mycobacterium abscessus
KW - Mycobacterium avium complex
KW - Scedosporium species complex
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U2 - 10.1513/AnnalsATS.201405-203AS
DO - 10.1513/AnnalsATS.201405-203AS
M3 - Article
C2 - 25167882
AN - SCOPUS:84912080439
SN - 2325-6621
VL - 11
SP - 1298
EP - 1306
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 8
ER -