British Medical Bulletin Advance Access originally published online on January 20, 2009
British Medical Bulletin 2009 89(1):93-110; doi:10.1093/bmb/ldn050
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Recent advances in the microbiology of respiratory tract infection in cystic fibrosis
Department of Microbiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 8RE, UK
* Correspondence to: Dr J. E. Foweraker, Department of Microbiology, Papworth Hospital HNS Foundation Trust, Papworth Everard, Cambridge CB3 8RE, UK E-mail: juliet.foweraker{at}papworth.nhs.uk
Introduction: Infection is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). Research on CF infection has highlighted differences from other respiratory infections—both in the range and the nature of the organisms—especially in chronic infection. This is a rapidly advancing field of microbiology and is bringing insights into the complexity and adaptations of bacteria causing chronic infection in the respiratory tract.
Areas of agreement and controversy: The epidemiology of some infections in CF has changed, with reduction in spread of Burkholderia cenocepacia following patient segregation. Conversely, epidemic strains of Pseudomonas aeruginosa have emerged, which spread between patients; previously, most P. aeruginosa strains were patient-specific. Studies on hypermutators, quorum sensing, biofilm growth and the development of molecular identification have shed light on pathogenicity, microbial adaptation to the host and complexity of infection in CF. Non-tuberculous mycobacteria are emerging pathogens in CF; however, there is much to learn about pathogenicity and treatment of these infections. Species of aerobic and anaerobic bacteria, more commonly encountered in the upper tract, are found in significant numbers in CF sputum. The significance of this is however under debate. Finally, although the clinical relevance of conventional antibiotic susceptibility testing for chronic CF pathogens has been questioned, there are no clear alternatives.
Emerging areas for developing research: Much has been learnt about pathogenicity, evolution of CF pathogens and development of antibiotic resistance. The need is to focus on clinical relevance of these observations to improve diagnosis, prevention and treatment of CF infection.
Keywords: cystic fibrosis • Pseudomonas aeruginosa • Burkholderia cepacia complex • non-tuberculous mycobacteria • Haemophilus influenzae • Staphylococcus aureus
Accepted for publication December 11, 2008.
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