PSEUDOMONAS CEPACIA IN THE RESPIRATORY FLORA OF PATIENTS WITH CYSTIC FIBROSIS (CF)

Abstract

Of 6364 respiratory tract cultures obtained from patients with CF from July 1973 to December 1976, 402 grew Pseudomonas(Ps.) cepacia. In 208 cultures, it was the single isolate, and in 194 it grew together with Staphylococcus aureus and/or Ps. aeruginosa, or together with other gram-negative organisms. A total of 54 patients, (2½ to 22 years), 32 females and 22 males, with mild (2), moderate(15) and advanced(37) degrees of CF has Ps. cepacia isolated from bronchial or sputum cultures. Ps. cepacia has been found in patients who have never been hospitalized and in those who rarely used aerosol therapy. It was recovered consistently for 2 to 3 years from 17 patients. Nine females and 5 males have died from respiratory failure. Premortem cultures in 12 patients grew Ps. cepacia alone or together with Ps. aeruginosa. In 10 autopsied cases, the lung culture grew Ps. cepacia alone in 3 and Ps. aeruginosa in 4. Ps. cepacia is resistant to almost all antimicrobials including nalidixlc acid and gantrisin but a few are sensitive to chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SXT) and kanamycin. Good clinical response has been observed in those treated with TMP-SXT or chloramphenicol. Transient disappearance of Ps. cepacia in post-therapy cultures has been achieved in a few cases. The significance of this finding is under study. The superinfection with Ps. cepacia of patients with CF with advanced disease has made the antimicrobial therapy more difficult.