Original articleImpact of Pseudomonas and Staphylococcus Infection on Inflammation and Clinical Status in Young Children with Cystic Fibrosis
Section snippets
Study Design
This cross-sectional study examined data from all subjects who had baseline BAL performed as part of 2 sequential multicenter clinical trials conducted by the CFF-TDN.23, 24 These studies were conducted with institutional review board approval at 12 centers between 2000 and 2005. Written informed consent was obtained for all enrolled subjects.
Inclusion criteria for both studies were the same, including age ≥ 6 months and < 6 years, diagnosis of CF, and at least 1 historical OP culture positive
Subject Characteristics
A total of 111 infants and young children with CF underwent baseline bronchoscopy. The subjects were categorized into 3 groups based on BALF culture results: BALF-positive for P aeruginosa (and possibly other CF bacterial pathogens), BALF-negative for P aeruginosa but positive for other CF bacterial pathogens, and BALF-negative for all CF bacterial pathogens. The clinical characteristics of each group at the time of BAL are summarized in Tables I (available at www.jpeds.com) and Table II.
Discussion
In this large multicenter study, we have demonstrated that young children with CF with lower airway P aeruginosa infection (ie, BALF-positive for P aeruginosa) had a greater degree of endobronchial inflammation (as marked by higher neutrophil counts, IL-8 levels, and free neutrophil elastase activity) and poorer clinical status (as marked by lower modified Shwachman scores) compared with those with only upper airway P aeruginosa–positive cultures. Lower airway S aureus infection also was found
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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.
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A list of additional members of the Inhaled Tobramycin in Young Children Study Group is available in the appendix (available at www.jpeds.com).