Selective pressure of antistaphylococcal chemotherapeutics in favour of Pseudomonas aeruginosa in cystic fibrosis.

Pseudomonas aeruginosa is insensitive against the majority of oral chemotherapeutics active against staphylococci. During application of such compounds in patients colonized by P. aeruginosa the concentration of P. aeruginosa increased in the majority of treatment episodes by factors between 2.5 and 50000. So, from a microbiological point of view the application of purely antistaphylococcal drugs should not be used prophylactically against staphylococci.

Selective procedure to isolate haemophilus influenzae from sputa with large quantities of Pseudomonas aeruginosa.

The identification of respiratory pathogens (e. g. Haemophilus influenzae, Streptococcus pneumoniae) is impaired by the presence of large quantities of Pseudomonas aeruginosa, as is the case in the sputum specimens of cystic fibrosis patients. A procedure has been evaluated whereby the selective inhibition of the proliferation of P. aeruginosa is achieved by a broad spectrum pyocin, whereas the growth of H. influenzae is not influenced. This technique has been tested over a two year period resulting in a significantly augmented rate of identification of H. influenzae.

Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis.

A microbiological analysis of 102 patients suffering from cystic fibrosis was conducted over a 22 month period. 20 microbial species with the following incidence were identified: Pseudomonas aeruginosa: 83.4%; Candida albicans: 29.4%; Staphylococcus aureus: 24.5%; Staphylococcus epidermidis: 11.8%; Haemophilus influenzae: 11.8%; Streptococcus pneumoniae; 6.9%; Pseudomonas maltophilia: 6.8%; Aspergillus fumigatus: 5.9%. Other species were present in less than 5% of the patients. In the majority of specimens with P. aeruginosa, more than one type (up to six) was detectable. These strains were identical in colony appearance, O-serotype and pyocin-type. Quantitative analysis revealed concentrations of colony-forming units of 10(7) to 10(9) for P. aeruginosa, 10(6) to 10(8) for P. maltophilia, 10(4) to 10(7) for S. aureus, 10(4) to 10(6) for S. epidermidis and 10(4) to 10(7) for C. albicans in the majority of specimens. Significant differences were observed in the time periods during which the pathogens persisted in the patients. Maximum persistence was observed for P. aeruginosa. P. maltophilia and A. fumigatus had about similar persistence rates, which were lower than those for P. aeruginosa but above those for S. aureus and H. influenzae. S. epidermidis was eliminated within shorter periods than S. aureus. C. albicans, although the second most frequent microorganism identified, showed a very low persistence rate. The microbiological analysis confirms results from other research centers (high incidence of P. aeruginosa), but reveals significant regional differences as well (Pseudomonas cepacia not detectable, higher incidence of P. maltophilia and C. albicans). This underlines the necessity for detailed qualitative and quantitative microbiological analysis of sputa from cystic fibrosis patients as a prerequisite for rational analysis of etiological, epidemiological and therapeutical aspects of cystic fibrosis.

Bacteriological effects of anti-Pseudomonas aeruginosa chemotherapy in cystic fibrosis.

Strains of Pseudomonas aeruginosa resistant to clinically relevant antibiotics (beta-lactams, quinolones, aminoglycosides) were detectable in sputa of cystic fibrosis patients. Correlations between in vitro susceptibility and bacteriological results in vivo were demonstrated at a quantitative level. P. aeruginosa strains susceptible prior to antibiotic therapy were observed to become resistant towards each of the compounds used for treatment. We conclude that antibiotic therapy in cystic fibrosis has to be optimized by culture specific selection of the drugs and consecutive bacteriological follow-ups.