Microbiological surveillance in cystic fibrosis – an emerging multifactorial challenge

ABSTRACT

Objectives: Accurate identification of airway pathogens with appropriate eradication and suppressive therapies is associated with improved health outcomes in cystic fibrosis (CF). From 2020, 2 key factors may have influenced the ability to carry out this monitoring effectively;1. the COVID- 19 pandemic accelerated a transition to ‘virtual’ clinic visits and 2. the introduction of ELX/TEZ/IVA. Methods:We retrospectively analysed out-patient clinic attendance in the month of November for the years 2017–2021 and microbiological samples received from adults with CF in the regional microbiology department. Results: The total number of microbiological samples reduced in 2020 and 2021 (Table 1). In 2017, 211 samples were generated from 261 clinic visits (80.8%). For subsequent years this was 80.0%, 71.0%, 51.2% and 72.2%, respectively. The proportion of cough swabs significantly increased in 2021, (p < 0.001). In 20216 postal sampleswere provided, indicating that yield of a sample from a virtual appointment was at most 8.3%. Table 1. Overview of microbiological samples and clinic visits November 2017–2021 (Table Presented)Conclusions: There has been a marked reduction in microbiological samples in the years 2020 and 2021 despite relative preservation of total clinic appointments. This appears to be partly due to an increase in virtual clinic attendance without adequate remote sampling. The disproportionate increase in cough swabs in 2021 can be attributed to ELX/TEZ/IVA availability resulting in decreased sputum burden. This work identifies challenges in monitoring patients established on highly effective modulator therapy in new clinic models