Question
How are common pathogens managed in patients with Cystic Fibrosis (CF)?
Answer
Let's look at different CF pathogens or bacteria. Pseudomonas are among the most common bacteria found in people with CF. More than 60% of adults with Cystic Fibrosis have cultured Pseudomonas. It is not a question of if they will get Pseudomonas, but rather when will they get Pseudomonas. When Pseudomonas is established in the airways, it is challenging to eliminate, but aggressive treatment can delay long-term infections. With the first acquisition of Pseudomonas, we do an eradication protocol, including oral Ciprofloxacin for two weeks and inhaled Tobramycin for a whole month.
If patients continue to colonize Pseudomonas, they will be on an antibiotic regimen. Including inhaled Tobramycin every other month or dual therapy, including Tobramycin one month and then another anti-pseudomonal drug, most often Casein, the following month. Other CF pathogens include methicillin-resistant staphylococcus aureus (MRSA), a prevalent bacteria found on skin surfaces. We only treat it during exacerbations. Burkholderia cepacia is another CF pathogen. This germs live in damp places and are often difficult to treat once it infects the lungs. Aspergillus is a common mold fungus found indoors or outdoors. It causes a disease called aspergillosis, which usually only develops in people with weakened immunity or lung disease.
Non-tuberculous mycobacteria (NTM) are another group of bacteria that can affect Cystic Fibrosis patients. This group of bacteria lives in soil, swamps, and water sources. NTM can survive many disinfectants and even severe environmental conditions. These have been found in a growing number of CF people, especially those with advanced lung disease. The treatment for NTM is very lengthy, usually, 6 to 12 months with several oral antibiotics, coupled with inhaled antibiotics. Therefore, the CF Foundation guidelines state that all CF patients who can expectorate sputum should have an acid-fast bacilli (ASB) culture sent annually to monitor NTM.
This Ask the Expert is an edited excerpt from the course, Cystic Fibrosis: A Comprehensive Overview, presented by Prigi Varghese, MSN, APRN, CPNP-PC.
