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Prevention of chronic infection with Pseudomonas aeruginosa infection in cystic fibrosis

Zemanick, Edith T.a; Bell, Scott C.b

Current Opinion in Pulmonary Medicine: November 2019 - Volume 25 - Issue 6 - p 636–645
doi: 10.1097/MCP.0000000000000616
CYSTIC FIBROSIS: Edited by Harry G.M. Heijerman and Nick Simmonds
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Purpose of review This review provides an update on definitions of chronicity of infection, approaches to airway sampling to detect infection, strategies for Pseudomonas aeruginosa eradication, impact of cystic fibrosis transmembrane regulator protein (CFTR) modulators and future challenges for clinical trials.

Recent findings Rates of P. aeruginosa have decreased over the past two decades with establishment of effective eradication protocols. Definitions of chronic P. aeruginosa infection have required adaptation for healthier populations. Although molecular (PCR) approaches to early P. aeruginosa detection are sensitive, to date, earlier diagnosis has not impacted on clinical outcomes. Despite eradication regimens, some people with early P. aeruginosa fail to clear their infection. Most people also experience a recurrence and eventual transition to chronic infection. Several recent studies sought to address this gap. CFTR modulators (predominantly ivacaftor) demonstrated reduced P. aeruginosa density, although infection may persist or recur demonstrating the need for continued antiinfective therapies in the modulator era.

Summary Future studies of approaches to P. aeruginosa eradication will be complex due to expanded availability and ongoing competitive clinical trials of CFTR modulators. Studies to address optimal eradication therapy, particularly in adults, will be required, though adequate recruitment to power these studies may prove challenging.

aDepartment of Paediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

bAdult Cystic Fibrosis Centre, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia

Correspondence to Scott C. Bell, Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, 4032 and QIMR Berghofer Medical Research Institute, Herston, 4029, Brisbane, Queensland, Australia. E-mail: scott.bell@qimrberghofer.edu.au

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