Introduction Although CF guidelines recommend that patients chronically infected with Pseudomonas aeruginosa should be offered inhaled antibiotics to help maintain pulmonary function and reduce exacerbation frequency, there is no such advice for those infected with Burkholderia spp, some of which confer a much worse prognosis.
Methods To look at the potential for this, we reviewed the microbiology of all adults attending our large unit (300 patients), paying attention to those with chronic Burkholderia infection, any co-existing pathogens, antibiotic sensitivity patterns, and the use of inhaled antibiotics.
Results Twenty two patients (7.3%) are infected with Burkholderia spp (6 multivorans, 8 cenocepacia, 1 genomovar IIIa cable pilus negative, 3 genomovar IIIb, 3 vietnamensis, and 1 dolosa. For sensitivity patterns (defined as >10 mm inhibition by disc diffusion) see Table 1. 9 patients (41%) are co-infected (4 with Pseudomonas aeruginosa, 3 Staph aureus, 2 MRSA, 1 Stenotrophomonas maltophilia).
Ten patients (none with cenocepacia) are using inhaled antibiotics (3 colistin, 1 Colobreath, 2 TOBI, 2 Cayston, 1 ceftazidime, 1 alternating Cayston and Promixin).
Conclusion This study shows that a significant proportion of our Burkholderia spp infected patients have organisms that are sensitive to currently available inhaled antibiotics. Given our positive experience, and with the expected availability of new inhaled antibiotics in the near future, perhaps the time has come to formally look at the use of inhaled anti-microbial therapy in this small but important cohort of CF patients.
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