Choosing the Right Antibiotic in Cystic Fibrosis Using the Sputum Microbiome

MRSA cell
MRSA cell
Sputum cultures could aid clinicians in choosing an appropriate antibiotic for patients with cystic fibrosis and avoiding allergies and antibiotic resistance.

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — The sputum microbiome may aid clinicians when choosing antibiotics for their patients with cystic fibrosis (CF), according to research presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology/World Allergy Organization (AAAAI/WAO), held March 2-5, in Orlando, Florida.

In this study, 271 patients with CF were identified and 369,721 patients without CF served as the control group (age range, 9 months to 66 years). Sputum culture results were available for 201 of the 271 patients with CF, and these data were used for comparison.

Of the patients with CF, 35.1% demonstrated more than 1 antibiotic allergy compared with 11% in the control group (P <.005). Patients with CF had allergies to penicillin (48.4%), cephalosporins (36.8%), vancomycin (24.2%), and fluoroquinolones (11.6%). The following pathogens were cultured from the sputum of patients with CF at ≥2-fold higher rates compared with the control group: Alcaligenes xylosoxidans, methicillin-resistant Staphylococcus aureus, methicillin-sensitive S aureus, mucoid Pseudomonas aeruginosa, and non-mucoid P aeruginosa.

Numerous additional pathogens were 2-fold less common in patients with CF: Enterobacter asburiae, Pantoea (formerly Enterobacter) agglomerans, Streptococcus pneumoniae, Klebsiella oxytoca (extended-spectrum beta-lactamase), K pneumoniaeMoraxella catarrhalis, and P fluorescens and P putida group.

The results of these cultures imply that patients with CF are “colonized with more virulent bacteria,” according to the researchers. “This could be secondary to previous infections or disease-related structural changes, making it possible [for] these microbes to be more prevalent.”

Future research on the relationship between the sputum microbiome and antibiotic allergy may help clinicians guide treatment and prevent antibiotic resistance in patients with CF.

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Jones R, Shah S, Howrylak J, Ishmael F. Associations between sputum microbiome and antibiotic allergy in patients with cystic fibrosis. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Poster 368.