RESUMEN
BACKGROUND: Infection with Burkholderia cepacia complex (Bcc) results in a heterogeneous clinical course ranging from asymptomatic colonization of the airways to fulminant respiratory failure in patients with cystic fibrosis (CF). Early eradication of Pseudomonas aeruginosa improves clinical outcomes. The efficacy and clinical outcomes following implementation of an eradication protocol for Bcc are less well understood. METHODS: We developed and implemented a single center Bcc eradication protocol that included an intensive combination of intravenous, inhaled, and oral antibiotic therapies based on in vitro sensitivities. We conducted a retrospective cohort analysis of clinical outcomes compared to patients with chronic Bcc infection. RESULTS: Six patients were identified as having a newly acquired Bcc colonization and were placed on the eradication protocol. Sequential sputum samples after completion of the protocol demonstrated sustained clearance of Bcc in all patients. Lung function and nutritional status remained stable in the year following eradication. CONCLUSION: Clearance of Bcc from sputum cultures using a standardized protocol was successful at one year and was associated with clinical stability.
Asunto(s)
Antibacterianos/administración & dosificación , Infecciones por Burkholderia/tratamiento farmacológico , Complejo Burkholderia cepacia , Fibrosis Quística/terapia , Neumonía Bacteriana/tratamiento farmacológico , Administración por Inhalación , Administración Intravenosa , Administración Oral , Adulto , Azitromicina/administración & dosificación , Infecciones por Burkholderia/complicaciones , Ceftazidima/administración & dosificación , Protocolos Clínicos , Estudios de Cohortes , Quimioterapia de Consolidación , Fibrosis Quística/complicaciones , Quimioterapia Combinada , Femenino , Humanos , Quimioterapia de Inducción , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Estudios Retrospectivos , Tobramicina/administración & dosificación , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Adulto JovenRESUMEN
Infertility and subfertility are commonly faced by females with cystic fibrosis (FwCF) and resulting in decreased contraceptive use and increased utilization of reproductive technologies. Elexacaftor-tezacaftor-ivacaftor (ETI) is a CFTR modulator that affects common causes of subfertility. Two CF centers conducted a retrospective chart review on females with CF who were receiving ETI and became pregnant. We analyzed obstetrical-gynecological history, genotype, and clinical response to ETI therapy. Fourteen FwCF on ETI became pregnant. Half (7) of the FwCFs were previously attempting to conceive, but only three were using contraceptives. Four FwCF had a history of infertility; two were reconsidering use of reproductive technologies (IUI). Patients achieved conception at mean 8 weeks after initiating ETI. ETI may lessen CF-associated factors that affect fertility; however, its exact mechanism is unknown. This warrants counseling on contraceptive use and family planning prior to initiation of therapy and at routine intervals while utilizing ETI.