TY - JOUR
T1 - Impact of Pseudomonas and Staphylococcus Infection on Inflammation and Clinical Status in Young Children with Cystic Fibrosis
AU - Sagel, Scott D.
AU - Gibson, Ronald L.
AU - Emerson, Julia
AU - McNamara, Sharon
AU - Burns, Jane L.
AU - Wagener, Jeffrey S.
AU - Ramsey, Bonnie W.
AU - Konstan, Michael
AU - Chatfield, Barbara
AU - Retsch-Bogart, George
AU - Waltz, David A.
AU - Acton, James
AU - Zeitlin, Pamela
AU - Hiatt, Peter
AU - Moss, Richard
AU - Wagener, Jeffrey
AU - Omlor, Greg
AU - Borowitz, Drucy
AU - Rosenfeld, Margaret
N1 - Funding Information:
Supported by grants from the National Institutes of Health (1 RO1 DK 57755-01, -02, K23 RR018611 -05, and U01 HL081335 -01), US Food and Drug Administration (FD-R-001695-01), Cystic Fibrosis Foundation Therapeutics Development Center Network, Novartis Corporation, and General Clinical Research Centers Program, National Center for Research Resources (MO1-RR00037, RR00046, RR00052, RR00064, RR00069, RR00070, RR00080, RR00188, RR02172, and RR08084). The authors declare no conflicts of interest.
PY - 2009/2
Y1 - 2009/2
N2 - Objective: To assess the effects of Pseudomonas aeruginosa and Staphylococcus aureus infection on lower airway inflammation and clinical status in young children with cystic fibrosis (CF). Study design: We studied 111 children age < 6 years who had 2 P aeruginosa-positive oropharyngeal cultures within 12 months. We examined bronchoalveolar lavage fluid (BALF) inflammatory markers (ie, cell count, differential, interleukin [IL]-8, IL-6, neutrophil elastase), CF-related bacterial pathogens, exotoxin A serology, and clinical indicators of disease severity. Results: Young children with CF with both upper and lower airway P aeruginosa infection had higher neutrophil counts, higher IL-8 and free neutrophil elastase levels, increased likelihood of positive exotoxin A titers, and lower Shwachman scores compared with those with positive upper airway cultures only. S aureus was associated with increased lower airway inflammation, and the presence of both P aeruginosa and S aureus had an additive effect on concentrations of lower airway inflammatory markers. BALF markers of inflammation were increased with the number of different bacterial pathogens detected. Conclusions: Young children with CF who have upper and lower airway P aeruginosa infection have increased endobronchial inflammation and poorer clinical status compared with those with only upper airway P aeruginosa infection. The independent and additive effects of S aureus on inflammation support the significance of polymicrobial infection in early CF lung disease.
AB - Objective: To assess the effects of Pseudomonas aeruginosa and Staphylococcus aureus infection on lower airway inflammation and clinical status in young children with cystic fibrosis (CF). Study design: We studied 111 children age < 6 years who had 2 P aeruginosa-positive oropharyngeal cultures within 12 months. We examined bronchoalveolar lavage fluid (BALF) inflammatory markers (ie, cell count, differential, interleukin [IL]-8, IL-6, neutrophil elastase), CF-related bacterial pathogens, exotoxin A serology, and clinical indicators of disease severity. Results: Young children with CF with both upper and lower airway P aeruginosa infection had higher neutrophil counts, higher IL-8 and free neutrophil elastase levels, increased likelihood of positive exotoxin A titers, and lower Shwachman scores compared with those with positive upper airway cultures only. S aureus was associated with increased lower airway inflammation, and the presence of both P aeruginosa and S aureus had an additive effect on concentrations of lower airway inflammatory markers. BALF markers of inflammation were increased with the number of different bacterial pathogens detected. Conclusions: Young children with CF who have upper and lower airway P aeruginosa infection have increased endobronchial inflammation and poorer clinical status compared with those with only upper airway P aeruginosa infection. The independent and additive effects of S aureus on inflammation support the significance of polymicrobial infection in early CF lung disease.
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U2 - 10.1016/j.jpeds.2008.08.001
DO - 10.1016/j.jpeds.2008.08.001
M3 - Article
C2 - 18822427
AN - SCOPUS:58149512622
SN - 0022-3476
VL - 154
SP - 183-188.e3
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -