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J Pediatr. 2009 Feb;154(2):183-8. doi: 10.1016/j.jpeds.2008.08.001. Epub 2008 Sep 25.

Impact of Pseudomonas and Staphylococcus infection on inflammation and clinical status in young children with cystic fibrosis.

Author information

1
Department of Pediatrics, The Children's Hospital and University of Colorado Health Sciences Center, Aurora, CO 80045, USA. sagel.scott@tchden.org

Abstract

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.

PMID:
18822427
PMCID:
PMC2654617
DOI:
10.1016/j.jpeds.2008.08.001
[Indexed for MEDLINE]
Free PMC Article

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