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Vol. 31. Issue 10.
Pages 494-500 (December 1995)
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Vol. 31. Issue 10.
Pages 494-500 (December 1995)
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Fibrosis quística: estudio microbiológico durante un período de 8 años
Cystic fibrosis: microbiological analysis over 8 years
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A. Ferrer Marcelles1, P. Bellver Moreira, G. Codina Grau, F. Fernández Pérez
Servicio de Microbiología y Parasitología. Unidad de Fibrosis Quística. Ciudad Sanitaria de la Vall d’Hebron. Universidad Autónoma de Barcelona
N. Cobos Barroso*, S. Liñán Cortés*
* Sección de Neumología Pediátrica. Unidad de Fibrosis Quística. Ciudad Sanitaria de la Valí d’Hebron. Universidad Autónoma de Barcelona
Article information
Objetivo

Estudiar la microbiología de la fibrosis quística en nuestro hospital durante los años 1985 a 1992.

Material y métodos

Se procesaron un total de 1.034 muestras, predominando esputos y aspirados nasofaríngeos, que correspondían a 113 pacientes, 64 varones y 49 mujeres, con una media de edad de 10 años (límites: 15 días-33 años).

Resultados y discusión

Solamente un 1,7% de las muestras fueron negativas y en un 10,8% creció flora normal, siendo el 87,4% restante positivas a uno o más microorganismos potencialmente patógenos. En el 77,8% de los cultivos cuantitativos el número de colonias fue superior a 106 UFC/ml. Globalmente los microorganismos aislados con más frecuencia fueron P. aeruginosa (53,9%), S. aureus (30,3%) y H. influenzae (22,0%), aunque en los pacientes menores de un año fueron significativamente superiores los aislamientos de S. pneumoniae y B. catarrhalis y en los pacientes mayores de 16 años de los hongos filamentosos, fundamentalmente Aspergillus spp. No se halló ninguna cepa de Legionella spp. y P. cepacia se aisló sólo en 3 pacientes, cuyo curso clínico fue favorable. En pacientes mayores de 11 años, junto a los tres patógenos clásicos, obtuvimos varios aislamientos consecutivos de Proteus mirabilis, Xanthomonas maltophilia y Serraría marcescens, lo que podría suponer en los próximos años, y debido al aumento de supervivencia de estos pacientes y a la presión antibiótica a que están sometidos, ligeros cambios en la ecología bacteriana típica de esta enfermedad.

Ninguna cepa de S. aureus resultó resistente a la meticilina y P. aeruginosa mostró una gran resistencia a la gentamicina (58,2%) entre los aminoglucósidos y a algunos betalactámicos considerados como tratamiento eficaz de este microorganismo: 25,2% a piperacilina, 22,6% a ceftazidima e incluso 19,8% al aztreonam, mostrando baja resistencia a la ciprofloxacina (6,3%).

Palabras clave:
Fibrosis quística
Microbiología
Colonización
Objective

To study the microbiology of cystic fibrosis in our hospital for the period from 1985 to 1992.

Material and methods

The number of samples analyzed totalled 1,034, most of which were sputum and nasopharyngeal aspirates belonging to 113 patients (49 women and 64 men). The average age was 10 years (range: 15 days-33 years).

Results and discussion

Only 1.7% of the samples were negative. Normal flora were found in 10.8% and one or more potentially pathogenic microorganisms were found in the remaining 87.4%. Colonies were over 106 UFC/ml in size in 77.8% of the quantified cultures. The most frequently identified microorganisms in the population overall were P. aeruginosa (53.9%), S. aureus (30.3%) and H. influenzae (22.0%). In patients less than 12 months oíd, however, the most common isolations were of S. pneumoniae and B. catarrhalis; cultures from patients older than 16 years oíd most often yielded filiform fungi, mainly Aspergillus spp. We found no strains of Legionella spp. and P. cepacia was found in only 3 cases, in which the clinical outcome was good. In addition to the 3 most common organisms, we recorded several consecutive isolations of Proteus mirabilis, Xanthomonas maltophilia and Serraría marcescens in patients older than 11 years oíd; this finding suggests that given the improved survival of cystic fibrosis patients over the coming years and the antibiotic pressure placed on them, there may be slight changes in the bacterial ecology typical of this disease.

No strain of S. aureus proved resistant to methicillin, but P. aeruginosa was shown to be resistant to gentamycin (58.2%) among the aminoglycosides and also to some of the p-lactams considered to be effective, as follows: 25.2% to piperacillin, 22.6% to ceftazidime and even 19.8% to aztreonam. There was slight resistance to ciprofloxacin (6.3%).

Key words:
Cystic fibrosis
Microbiology
Colonization
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Bibliografía
[1.]
P. Kubesch, T. Dörk, U. Wulbrand, N. Kálin, T. Neumann, B. Wulf, et al.
Genetic determinaras of airways’ colonization with Pseudomonas aeruginosa in cystic fibrosis.
The Lancet, 341 (1993), pp. 189-193
[2.]
J.A. Molina.
Fibrosis quística. Otras afecciones pancreáticas.
Tratado de pediatría,
[3.]
M. Ojeda-Vargas.
Fibrosis quística: perspectivas e implicaciones microbiológicas.
Rev Esp Microbiol Clin, 4 (1990), pp. 187-188
[4.]
C.I. Taylor, J. Me Gaw, R. Howden, Duerden Bl, P.S. Baxter.
Bacterial reservoirs in cystic fibrosis.
Arch Dis Child, 65 (1990), pp. 175-177
[5.]
M.M. Brett, A.T.M. Ghoneim, J.M. Littlewood.
Prediction and diagnosis of early Pseudomonas aeruginosa infection in cystic fibrosis: a follow-up study.
1 Microbiol, 26 (1988), pp. 1.565-1.570
[6.]
N. Hoiby.
Microbiology of lung infections in cystic fibrosis patients.
Acta Paediatr Scand, 301 (1982), pp. 33-54
[7.]
J. De Gracia, A. Urrutia, A. Guarga, Joanmiquel Ll, E. Monso, R. Vidal.
Fibrosis quística en el adulto.
Med Clin (Barc), 83 (1984), pp. 392-393
[8.]
Anónimo.
Fibrosis quística e infección por Pseudomonas.
Lancat (ed. esp.), 3 (1983), pp. 453-455
[9.]
A. Bavernfeind, R.M. Bertele, K. Harms, et al.
Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis.
Infection, 15 (1987), pp. 270-277
[10.]
N. Floiby.
Haemophilus mfluenzae.
Staphylococcus aureus. Pseudomonas cepacia and Pseudomonas aeruginosa in patients with cystic fibrosis. Chest, 94 (1988), pp. 97-103
[11.]
A.R.L. Penketh, A. Wise, M.B. Mearns, M.E. Flodson, J.C. Batten.
Cystic fibrosis in adolescents and adults.
Thorax, 42 (1987), pp. 526-532
[12.]
B. Pérez Gorricho.
Patología infecciosa y quimioterapia en fibrosis quística.
Revisión bibliográfica. Rev Esp Quimioterap, 2 (1989), pp. 309-315
[13.]
J.R. May, N.C. Flerrick, D. Thompson.
Bacterial infection in cystic fibrosis.
Arch Dis Child, 47 (1972), pp. 908-913
[14.]
P.R. Murray, J.A. Washington.
Microscopic and bacteriologic analysis of expectorated sputum.
Mayo Clinic Proc, 50 (1975), pp. 339-344
[15.]
K. Pirtle, S.W. Monroe, T.K. Smalley, J.A. Mohr, E.R. Rhoades.
Diagnostic and therapeutic advantages of serial cuantitativecultures of fresch sputum in acute bacterial pneumonia.
Am J Respir Dis, 100 (1969), pp. 831-838
[16.]
E. Sadeghi, A. Matlow, Mac Lusky, A. Karmali.
Utility of gram stain in evaluation of sputa from patients with cystic fibrosis.
J Clin Microbiol, 32 (1994), pp. 54-58
[17.]
K.E. Berkin, S.R. Alcock, H.R. Stack.
Cystic fibrosis, a review of 26 adolescent and adult patients.
Eur J Respir Dis, 67 (1985), pp. 103-111
[18.]
P. Gilligan.
Microbiology of airway disease in patients with cystic fibrosis.
Clin Microbiol Rev, 4 (1991), pp. 35-51
[19.]
G. Doring, M. Maier, E. Müller, Z. Bibi, B. Tümmler, A. Kharazmi.
Virulence factors of Pseudomonas aeruginosa.
Antibiot Chemother, 39 (1987), pp. 136-148
[20.]
B. Wretlind, O.R. Pavlovskis.
The role of proteases and exotoxin A in the pathogenicity of Pseudomonas aeruginosa infections.
Scand J Infect Dis, (1981), pp. 13-19
[21.]
T.B. May, D. Shinabarger, R. Maharaj, et al.
Alginate synthesis by Pseudomonas aeruginosa: a key pathogenic factor in chronic pulmonary infections of cystic fibrosis patients.
Clin Microbiol Rev, 4 (1991), pp. 191-206
[22.]
N.M. Kelly, F.R. Falkiner, C.T. Keane, M.X. Fitzgerald, E. Tempany.
Mucoid gram-negative bacilli in cystic fibrosis.
[23.]
K. McCowan.
The microbiology associated with cystic fibrosis.
Clin Microbiol Newslet, 10 (1988), pp. 9-16
[24.]
M.I. Marks.
Clinical significance of Slaphylococcus aureus in cystic fibrosis.
Infection, 18 (1990), pp. 53-56
[25.]
B. Boxerbaum, R.J. Jacobs, R.L. Cechner.
Prevalence and significance of methicillin-resistant Slaphylococcus aureus in patients with cystic fibrosis.
Pediatric Pulmonology, 4 (1988), pp. 159-163
[26.]
A. Bauerfeind, G. Horl, B. Przyklenk.
Microbiologic and therapeutic aspects of Slaphylococcus aureus in cystic fibrosis patients.
Scand J Gastroenterol, 23 (1988), pp. 99-102
[27.]
M. Corey, L. Allison, C. Prober, H. Levison.
Sputum bacteriology in patients with cystic fibrosis in a Toronto hospital during 1970-1981.
J Infect Dis, 149 (1984), pp. 283
[28.]
K.C. Watson, E.J.C. Kerr, M. Bailie.
Temporal changes in biotypes of Haemophilus injluenzae isolated from patients with cystic fibrosis.
J Med Microbiol, 26 (1988), pp. 129-132
[29.]
K.C. Watson, E.J.C. Kerr, C.A. Hinks.
Distribution of biotypes of Haemophilus ir.fluenzae in patients with cystic fibrosis.
J Clin Pathol, 38 (1985), pp. 750-753
[30.]
N. Hoiby, M. Kilian.
Haemophilus from the lower respiratory tract of patients with cystic fibrosis.
Scand J Resp Dis, 57 (1976), pp. 103-107
[31.]
V. Bhargava, J.F. Tomashefsky, R.C. Stern, C.R. Abramowsky.
The pathology of fungal infection and colonization in patients with cystic fibrosis.
Human Pathology, 20 (1989), pp. 977-986
[32.]
M.J. Thomassen, C.A. Demko, J.D. Klinger, R.C. Stern.
Pseudomonas cepacia colonization among patients with cystic fibrosis.
Am Resp Dis, 131 (1985), pp. 791-796
[33.]
D.A. Goldmann, J.D. Klinger.
Pseudomonas cepacia: biology mechanisms of virulence, epidemiology.
J Pediatr, 108 (1986), pp. 806-812
[34.]
O.C. Tablan, L.A. Carson, L.B. Cusick, L.A. Bland, W.J. Martone, W.R. Jarvis.
Laboratory proficiency test results on use of selective media for isolating Pseudomonas cepacia from simulated sputum specimens of patients with cystic fibrosis.
J Clin Microbiol, 25 (1987), pp. 485-487
[35.]
D.F. Welch, M.J. Muszkinsky, C.H. Pai, et al.
Selective and differential médium for recovery of Pseudomonas cepacia form the respiratory tracts of patients with cystic fibrosis.
J Clin Microbiol, 25 (1987), pp. 1.730-1.734
[36.]
E.L. Cong, M.E. Ellis, A.K. Webb, K.R. Neal, M. Dodd, E.O. Caul.
Infective respiratory exacerbations in young adults with cystic fibrosis: role of viruses and atypical microorganisms.
Thorax, 44 (1989), pp. 739-742
[37.]
J. Efthimiou, M.E. Hodson, P. Taylor, A.G. Taylor, J.C. Batten.
Importance of viruses and Legionella pneumophila in respiratory exacerbations of young adults with cystic fibrosis.
Thorax, 39 (1984), pp. 150-154
[38.]
M. Ojeda-Vargas, A. Pacheco, M. Elia, R. Villaverde, F. Baquero.
Proleus mirabílis as a cause of recurrent lung infection in a cystic fibrosis patient.
Eur J Clin Microbiol Infect Dis, 9 (1990), pp. 234-235
Copyright © 1995. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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