Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;21(5):753-758.
doi: 10.1016/j.jcf.2022.04.006. Epub 2022 Apr 22.

Antipseudomonal treatment decisions during CF exacerbation management

D R VanDevanter  1 , N E West  2 , D B Sanders  3 , M Skalland  4 , C H Goss  5 , P A Flume  6 , S L Heltshe  7
Affiliations

Antipseudomonal treatment decisions during CF exacerbation management

D R VanDevanter et al. J Cyst Fibros. 2022 Sep.

Abstract

Background: Cystic fibrosis (CF) pulmonary exacerbation (PEx) treatment guidelines suggest that Pseudomonas aeruginosa (Pa) airway infection be treated with two antipseudomonal agents.

Methods: We retrospectively studied treatment responses for STOP2 PEx treatment trial (NCT02781610) participants with a history of Pa infection. Mean lung function and symptom changes from intravenous (IV) antimicrobial treatment start to Visit 2 (7 to 10 days later) were compared between those receiving one, two, and three+ antipseudomonal classes before Visit 2 by ANCOVA. Odds of PEx retreatment with IV antimicrobials within 30 days and future IV-treated PEx hazard were modeled by logistic and Cox proportional hazards regression, respectively. Sensitivity analyses limited to the most common one-, two-, and three-class regimens, to only IV/oral antipseudomonal treatments, and with more stringent Pa infection definitions were conducted.

Results: Among 751 participants, 50 (6.7%) were treated with one antipseudomonal class before Visit 2, while 552 (73.5%) and 149 (19.8%) were treated with two and with three+ classes, respectively. Females and participants with a negative Pa culture in the prior month were more likely to be treated with a single class. The most common single, double, and triple class regimens were beta-lactam (BL; n = 42), BL/aminoglycoside (AG; n = 459), and BL/AG/fluoroquinolone (FQ; n = 73). No lung function or symptom response, odds of retreatment, or future PEx hazard differences were observed by number of antipseudomonal classes administered in primary or sensitivity analyses.

Conclusions: We were unable to identify additional benefit when multiple antipseudomonal classes are used to treat PEx in people with CF and Pa.

Keywords: Antipseudomonal classes; P. aeruginosa; Pulmonary exacerbation.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

The authors claim no financial conflicts of interest related to this work.

Figures

Figure 1.
Figure 1.. Mean lung function and symptom scores at study visits by number of antipseudomonal classes administered prior to Visit 2.
Upper panel: mean ppFEV1 values. Lower panel: mean CRISS values. Participants treated with one, two, or three or more antipseudomonal classes are presented as black, gray, and white circles, respectively. Bars are 95% confidence intervals (CI).
Figure 2.
Figure 2.. Odds ratios for treatment with a new antipseudomonal agent or class on or after Visit 2.
Black circles, odds ratios for treatment with a new antipseudomonal agent on or after Visit 2. Gray circles, odds ratios for treatment with a new antipseudomonal class on or after Visit 2. Bars are 90% confidence intervals (CI). CFFPR, CF Foundation Patient Registry.
Figure 3.
Figure 3.. Odds ratio for retreatment for PEx within 30 days of treatment end and hazard ratios for future PEx treated with IV antimicrobials.
Left panel, odds of retreatment. Right panel, future PEx hazard. Bars represent 95% confidence intervals (CI). AntiPa, antipseudomonal; CFFPR, CF Foundation Patient Registry.
See this image and copyright information in PMC

References

    1. Konstan MW, Morgan WJ, Butler SM, Pasta DJ, Craib ML, Silva SJ, Stokes DC, Wohl ME, Wagener JS, Regelmann WE, Johnson CA; Scientific Advisory Group and the Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Risk factors for rate of decline in forced expiratory volume in one second in children and adolescents with cystic fibrosis. J Pediatr. 2007. Aug;151(2):134–9, 139.e1. - PubMed
    1. Konstan MW, Wagener JS, VanDevanter DR, Pasta DJ, Yegin A, Rasouliyan L, Morgan WJ. Risk factors for rate of decline in FEV1 in adults with cystic fibrosis. J Cyst Fibros. 2012. Sep;11(5):405–11. - PMC - PubMed
    1. Liou TG, Adler FR, Fitzsimmons SC, Cahill BC, Hibbs JR, Marshall BC. Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol 2001; 153(4): 345–52. - PMC - PubMed
    1. Mayer-Hamblett N, Rosenfeld M, Emerson J, Goss CH, Aitken ML. Developing cystic fibrosis lung transplant referral criteria using predictors of 2-year mortality. Am J Respir Crit Care Med. 2002; 166(12 Pt 1):1550–5. - PubMed
    1. Ratjen F, Döring G. Cystic fibrosis. Lancet. 2003. Feb 22;361(9358):681–9. Review. - PubMed

Publication types