Early respiratory bacterial detection and anti-staphylococcal antibiotic prophylaxis in young children with cystic fibrosis

Hurley, Matthew; Fogarty, Andrew W.; McKeever, Tricia M.; Goss, Christopher; Rosenfeld, Margaret; Smyth, Alan R.

Abstract

Rationale: Consensus is lacking regarding anti-staphylococcal antibiotic prophylaxis use for young children with cystic fibrosis. Prophylaxis is recommended in the UK, but recommended against in the US.
Objectives: To test the hypothesis that anti-staphylococcal antibiotic prophylaxis is associated with a decreased risk of Staphylococcus aureus acquisition, but no increased risk of Pseudomonas aeruginosa acquisition.

Methods: We undertook a longitudinal observational study of children with cystic fibrosis who were recruited from birth (or their first registry entry in the period) and followed until the age of 4 years (1500 days) using UK CF Trust and US CF Foundation Registries, 2000-2009. Children were excluded if they had a culture positive for S. aureus or P. aeruginosa, or were receiving inhaled antibiotics, at first encounter. Time to first S.aureus and P. aeruginosa detection in the UK/US cohorts were compared using a Cox proportional hazards model. A UK-based analysis compared the same for those receiving flucloxacillin with those who received no prophylaxis. We included the following covariates: sex, age at registry entry, Dornase alfa use, genotype and center size.

Results: The primary analysis consisted 1074 UK and 3677 US children. The risk of first detection was greater in US compared to UK for S. aureus (hazard ratio (HR) 5.79; 95% CI: 4.85, 6.90; p

Citation

Hurley, M., Fogarty, A. W., McKeever, T. M., Goss, C., Rosenfeld, M., & Smyth, A. R. (in press). Early respiratory bacterial detection and anti-staphylococcal antibiotic prophylaxis in young children with cystic fibrosis. Annals of the American Thoracic Society, https://doi.org/10.1513/AnnalsATS.201705-376OC

• Journal Article Type: Article
• Acceptance Date: Oct 11, 2017
• Online Publication Date: Oct 16, 2017
• Deposit Date: Oct 30, 2017
• Publicly Available Date: Oct 17, 2018
• Journal: Annals of the American Thoracic Society
• Print ISSN: 2329-6933
• Electronic ISSN: 2325-6621
• Publisher: American Thoracic Society
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1513/AnnalsATS.201705-376OC
• Keywords: Cystic fibrosis; Children; Antibiotics; Prophylaxis; Infection
• Public URL: https://nottingham-repository.worktribe.com/output/888103
• Publisher URL: https://doi.org/10.1513/AnnalsATS.201705-376OC