RESUMO
BACKGROUND: In patients with cystic fibrosis (CF) the sinuses are a bacterial reservoir for Gram-negative bacteria (GNB). From the sinuses the GNB can repeatedly migrate to the lungs. In a one-year follow-up study, endoscopic sinus surgery (ESS) with adjuvant therapy reduced the frequency of pulmonary samples positive for GNB. We investigated whether the effect is sustained. METHODOLOGY: We report the effect of ESS and adjuvant therapy three years postoperatively in a CF cohort participating in this prospective clinical follow-up study. The primary endpoint was the lung infection status defined by Leeds criteria. RESULTS: One hundred and six CF patients underwent ESS; 27 had improved lung infection status after three years. The prevalence of patients free of lung colonization with GNB significantly increased from 16/106 patients (15%) preoperatively to 35/106 patients (33%) after three years. The total cohort had decreasing lung function during follow-up; however, in 27 patients with improved lung infection status lung function was stable. Revision surgery was performed in 31 patients (28%). CONCLUSION: ESS with adjuvant therapy significantly improves the lung infection status for at least three years in our cohort of patients with CF and may postpone chronic lung infection with GNB and thus stabilize lung function.
Assuntos
Fibrose Cística/cirurgia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Seios Paranasais/cirurgia , Pneumonia Bacteriana/prevenção & controle , Adolescente , Adulto , Antibacterianos/uso terapêutico , Quimioterapia Adjuvante , Criança , Doença Crônica , Fibrose Cística/microbiologia , Fibrose Cística/fisiopatologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Seios Paranasais/microbiologia , Seios Paranasais/fisiopatologia , Estudos Prospectivos , Testes de Função Respiratória , Sistema Respiratório/microbiologia , Sistema Respiratório/fisiopatologia , Adulto JovemRESUMO
The biofilm mode of growth is the survival strategy of environmental bacteria like Pseudomonas aeruginosa. Such P. aeruginosa biofilms also occur in the lungs of chronically infected cystic fibrosis patients, where they protect the bacteria against antibiotics and the immune response. The lung tissue damage is due to immune complex mediated chronic inflammation dominated by polymorphonuclear leukocytes releasing proteases and oxygen radicals.
Assuntos
Fibrose Cística/microbiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/fisiologia , Animais , Antibacterianos/farmacologia , Biofilmes , Doença Crônica , Fibrose Cística/imunologia , Resistência Microbiana a Medicamentos , Endopeptidases/metabolismo , Humanos , Inflamação/imunologia , Pulmão/microbiologia , Pulmão/patologia , Neutrófilos/metabolismo , Pseudomonas aeruginosa/efeitos dos fármacosRESUMO
In cystic fibrosis (CF) neutrophil released serine proteinase activity may facilitate Pseudomonas aeruginosa lung colonization, leading to chronic infection. Since such activity is mostly controlled by alpha 1-antitrypsin (alpha 1-AT), we postulated that with CF carrying deficient alpha 1-AT variants might be at higher risk for P. aeruginosa acquisition and might reveal other phenomena, specific for serine proteinase activity. In 215 Danish patients with CF, homozygous (80%) or heterozygous (20%) for the major CF mutation deltaF508, alpha 1-AT variants were determined. Carriage of deficient alpha 1-AT variants was correlated to an earlier onset of P. aeruginosa lung infection (P < 0.0001), higher total IgG (P < 0.0001), and P. aeruginosa-specific serum antibodies (P < 0.0001). The two groups did not differ in lung function, probably due to intensive antimicrobial treatment.