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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries.

Standard versus biofilm antibiotic testing to guide antibiotic treatment in cystic fibrosis

This version published: 2012; Review content assessed as up-to-date: August 02, 2012.

Plain language summary

The main cause of death in people with cystic fibrosis is due to chronic lung infection. Antibiotic treatments have helped people with cystic fibrosis live longer lives. Antibiotics are typically chosen based on testing them against bacteria (bugs) grown in liquid in the laboratory. However, bacteria such as Pseudomonas aeruginosa, do not grow in liquid in the lungs of people with cystic fibrosis, but rather in a slime layer called a biofilm. Laboratory testing of antibiotics against Pseudomonas aeruginosa grown in a biofilm rather than in liquid may provide results that lead to better antibiotic choices with better clinical outcomes in the treatment of pulmonary infections in people with cystic fibrosis. 

We were able to include one trial in this review. It was a multicentre, randomized, double‐blind controlled clinical trial with 39 participants; 20 in the biofilm group and 19 in the conventional group. The trial looked at whether using the results of testing antibiotics against Pseudomonas aeruginosa grown as a biofilm rather than in liquid improved outcomes in people with cystic fibrosis with lung infections. The main outcome was the decrease in the amount of bacteria in the sputum of each participant, before and after antibiotic treatment, in each group. There was no difference in the reduction of sputum bacteria or in the improvement in lung function between the two groups. The intervention was equally safe in both groups.   

The trial was limited by the small number of participants and the fact that antibiotics were given when the patients were well, which is not what is usually done in clinical practice. However, the trial showed that choosing antibiotics to treat people with cystic fibrosis based on biofilm testing is a safe intervention. Further clinical trials on this topic are needed to address some of these current limitations.

Abstract

Background: The antibiotics used to treat pulmonary infections in people with cystic fibrosis are typically chosen based on the results of antimicrobial susceptibility testing performed on bacteria traditionally grown in a planktonic mode (grown in a liquid). However, there is considerable evidence to suggest that Pseudomonas aeruginosa actually grows in a biofilm (or slime layer) in the airways of cystic fibrosis patients with chronic pulmonary infections. Therefore, choosing antibiotics based on biofilm rather than conventional antimicrobial susceptibility testing could potentially improve response to treatment of Pseudomonas aeruginosa in people with cystic fibrosis.

Objectives: To compare biofilm antimicrobial susceptibility testing‐driven therapy to conventional antimicrobial susceptibility testing‐driven therapy in the treatment of Pseudomonas aeruginosa infection in people with cystic fibrosis.

Search methods: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched a registry of ongoing trials and the reference lists of relevant articles and reviews.

Most recent search: 02 August 2012.

Selection criteria: Randomized controlled trials of antibiotic therapy based on biofilm antimicrobial susceptibility testing compared to antibiotic therapy based on conventional antimicrobial susceptibility testing in the treatment of Pseudomonas aeruginosa pulmonary infection in individuals with cystic fibrosis.

Data collection and analysis: Both authors independently selected trials, assessed their risk of bias and extracted data from eligible trials. Additionally, the authors contacted the trial investigators to obtain further information.

Main results: The search identified one multicentre, randomized, double‐blind controlled clinical trial eligible for inclusion in the review (39 participants). This trial prospectively assessed whether the use of biofilm antimicrobial susceptibility testing improved microbiological and clinical outcomes in participants with cystic fibrosis who were infected with Pseudomonas aeruginosa. The primary outcome was the change in sputum Pseudomonas aeruginosa density from the beginning to the end of antibiotic therapy. The mean (standard deviation) change in density in log10 colony forming units per gram was ‐2.94 (2.83) in the biofilm group and ‐3.27 (3.09) in the control group, for a mean difference of 0.28 (95% confidence interval ‐1.98 to 2.54) (P = 0.8). The data did not provide evidence that biofilm susceptibility testing was superior to conventional susceptibility testing.

Authors' conclusions: The current evidence is insufficient to recommend choosing antibiotics based on biofilm antimicrobial susceptibility testing rather than conventional antimicrobial susceptibility testing in the treatment of Pseudomonas aeruginosa pulmonary infections in people with cystic fibrosis. Future randomized clinical trials on this topic may shed further light on this question.

Editorial Group: Cochrane Cystic Fibrosis and Genetic Disorders Group.

Publication status: New.

Citation: Waters V, Ratjen F. Standard versus biofilm antimicrobial susceptibility testing to guide antibiotic therapy in cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD009528. DOI: 10.1002/14651858.CD009528.pub2. Link to Cochrane Library. [PubMed: 23152277]

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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