Antibiotic management of lung infections in cystic fibrosis: II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi

James F. Chmiel, Timothy Aksamit, Sanjay H. Chotirmall, Elliott C. Dasenbrook, J. Stuart Elborn, John J. LiPuma, Sarath C. Ranganathan, Valerie J. Waters, Felix A. Ratjen

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Airway infections are a key component of cystic fibrosis (CF) lung disease. Whereas the approach to common pathogens such as Pseudomonas aeruginosa is guided by a significant body of evidence, other infections often pose a considerable challenge to treating physicians. In Part I of this series on the antibiotic management of difficult lung infections, we discussed bacterial organisms including methicillin-resistant Staphylococcus aureus, gram-negative bacterial infections, and treatment of multiple bacterial pathogens. Here, we summarize the approach to infections with nontuberculous mycobacteria, anaerobic bacteria, and fungi. Nontuberculous mycobacteria can significantly impact the course of lung disease in patients with CF, but differentiation between colonization and infection is difficult clinically as coinfection with other micro-organisms is common. Treatment consists of different classes of antibiotics, varies in intensity, and is best guided by a team of specialized clinicians and microbiologists. The ability of anaerobic bacteria to contribute to CF lung disease is less clear, even though clinical relevance has been reported in individual patients. Anaerobes detected in CF sputum are often resistant to multiple drugs, and treatment has not yet been shown to positively affect patient outcome. Fungi have gained significant interest as potential CF pathogens. Although the role of Candida is largely unclear, there is mounting evidence that Scedosporium species and Aspergillus fumigatus , beyond the classical presentation of allergic bronchopulmonary aspergillosis, can be relevant in patients with CF and treatment should be considered. At present, however there remains limited information on how best to select patients who could benefit from antifungal therapy.

Original languageEnglish (US)
Pages (from-to)1298-1306
Number of pages9
JournalAnnals of the American Thoracic Society
Volume11
Issue number8
DOIs
StatePublished - Oct 1 2014

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Nontuberculous Mycobacteria
Anaerobic Bacteria
Cystic Fibrosis
Fungi
Anti-Bacterial Agents
Lung
Infection
Lung Diseases
Nontuberculous Mycobacterium Infections
Gram-Negative Bacterial Infections
Scedosporium
Allergic Bronchopulmonary Aspergillosis
Therapeutics
Aspergillus fumigatus
Methicillin-Resistant Staphylococcus aureus
Sputum
Coinfection
Candida
Bacterial Infections
Pseudomonas aeruginosa

Keywords

  • Anaerobic bacteria
  • Aspergillus fumigatus
  • Mycobacterium abscessus
  • Mycobacterium avium complex
  • Scedosporium species complex

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Antibiotic management of lung infections in cystic fibrosis : II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi. / Chmiel, James F.; Aksamit, Timothy; Chotirmall, Sanjay H.; Dasenbrook, Elliott C.; Stuart Elborn, J.; LiPuma, John J.; Ranganathan, Sarath C.; Waters, Valerie J.; Ratjen, Felix A.

In: Annals of the American Thoracic Society, Vol. 11, No. 8, 01.10.2014, p. 1298-1306.

Research output: Contribution to journalArticle

Chmiel, JF, Aksamit, T, Chotirmall, SH, Dasenbrook, EC, Stuart Elborn, J, LiPuma, JJ, Ranganathan, SC, Waters, VJ & Ratjen, FA 2014, 'Antibiotic management of lung infections in cystic fibrosis: II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi', Annals of the American Thoracic Society, vol. 11, no. 8, pp. 1298-1306. https://doi.org/10.1513/AnnalsATS.201405-203AS
Chmiel, James F. ; Aksamit, Timothy ; Chotirmall, Sanjay H. ; Dasenbrook, Elliott C. ; Stuart Elborn, J. ; LiPuma, John J. ; Ranganathan, Sarath C. ; Waters, Valerie J. ; Ratjen, Felix A. / Antibiotic management of lung infections in cystic fibrosis : II. Nontuberculous mycobacteria, anaerobic bacteria, and fungi. In: Annals of the American Thoracic Society. 2014 ; Vol. 11, No. 8. pp. 1298-1306.
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