P240 Longitudinal study of sputum microbiology in adult non-CF bronchiectasis
Introduction and Objectives Monitoring longitudinal sputum microbiology in adults with non-CF bronchiectasis (nCF-Br) is a key strategy in guiding targeted antibiotic therapy. There is minimal published data on the microbiological profile over time in bronchiectasis.1 2 Similar to CF, greater pathogen diversity is now being observed; hence we have revisited this area.
Methods 12 years of previous sputum culture results obtained from 143 nCF-Br patients attending a specialist clinic were retrospectively reviewed. ‘Colonisation’ (organism cultured ≥2 occasions, 3 months apart within 1-year period) and ‘isolation’ (organism cultured ≥1) were recorded.
Results 88F, 55M patients; average age 60.6 (range 16–90); average FEV1 65% predicted (SD ± 26%). The most common pathogens were Haemophilus influenzae (52% isolated and 33% colonisation; 8% were beta-lactam producing) and Pseudomonas aeruginosa (43% isolated and 35% colonisation) whilst 20% patients had no pathogens cultured. 81 patients (57%) have never had Pseudomonas. Of 62 patients (43%) isolating Pseudomonas, 12 patients (8%) had single isolates, 8 (6%) had colonisation with successful eradication therapy. Streptococcus pneumoniae (34%), Coliforms (30%), Moraxella catarrhalis (27%), Staphylococcus aureus (24%) were other common isolates. Rarer pathogens include Aspergillus sp. (9%), S.maltophilia (8%), non-tuberculous mycobacteria (NTM 3%; M. terrae, M. avium and M. simiae), MRSA(3%), Acinetobacter sp. (3%) and Achromobacter xylosoxidans (3%).
Conclusions We note similar rates of H. influenzae colonisation as previously (33% vs 40%1) but higher rates of Pseudomonas colonisation (35% vs 18%1 and 24%2). Including those with any prior Pseudomonas, the rates of Pseudomonas isolation reach as high as 43% (higher than reported at 31%2). Our unit receives referrals from the local immunodeficiency centre and other respiratory units but this is not felt to account for the high Pseudomonas rates. Ongoing surveillance of individual and geographically local microbiological profiles is important in managing patients with nCF-Br.