Bell, S.C.

Geake, J.

Sandhu, H.K.

Elsevier - Publisher Connector 

107 Time trends in clinical indicators for cystic fibrosis (CF) patients at transition to adult care 

Posters 6. Microbiology S73
105 Evaluation of fungal diagnostic stains and prolonged sputum
culture in cystic ﬁbrosis fungal disease
I.C. Felton1, S. Benson2, K. Alshaﬁ2, A.G. Nicholson3, N.J. Simmonds1,
D. Bilton1. 1Royal Brompton & Hareﬁeld NHS Foundation Trust, Adult Cystic
Fibrosis, London, United Kingdom; 2Royal Brompton & Hareﬁeld NHS Foundation
Trust, Microbiology, London, United Kingdom; 3Royal Brompton & Hareﬁeld NHS
Foundation Trust, Histopathology, London, United Kingdom
Objectives: Standard culture may fail to detect fungal pathogens. Reliance upon
this technique alone amidst clinical decline or antifungal therapy can make clinical
decision-making and disease-monitoring challenging. This pilot study aims to
further evaluate the CF fungal airways burden in recognition of this unmet clinical
need.
Methods: 16 adult CF patients with a spectrum of fungal disease provided
spontaneous sputum samples at a single timepoint to be examined by 3 different
techniques: (1) Prolonged fungal cultures (Sabouraud’s Dextrose Agar + chloram-
phenicol and Dermasel Agar incubated at 37ºC 48 h then 30ºC and interpreted
at Day 7, D14, D21, D28). (2) Microbiology stain: Calcoﬂuor White (CFW)
(3) Cytology stain: Grocott’s Methenamine Silver (GMS).
Results: Prolonged fungal culture (>D7) yielded a positivity rate of 57% compared
to 35% of samples at <D7. However CFW stain revealed fungal elements eg.
hyphae, in 75% of samples. GMS stain revealed fungal ﬁndings in 73%. Of the
fungal culture-negative samples, stains detected fungal elements in up to 50%
(CFW 33%, GMS 50%).
Conclusion: Whilst the sample size in this preliminary cohort is small, the
clinical utility for additional evaluation of fungal disease by a panel of laboratory
techniques available to most hospital pathology departments is highlighted. Of
note, Scedosporium apiospermum and Exophiala dermatitidis, two emerging fungal
pathogens required >D7 culture. GMS stain a had greater detection rate for fungal
elements compared to CFW in the fungal culture-negative samples. The evaluation
of these techniques in monitoring disease over time and for early detection of fungal
infection forms the focus of the next stage of this study.
106 Epidemiological study of Achromobacter xylosoxidans in a
reference center for CF treatment in Brazil
C.P.C. Capizzani1, N.C. Cac¸ador1, L.A.G.M.M. Torres2, M.I.M. Fernandes2,
R. Martinez3, L. Tonani1, L.A. Pereira3, A.L.C. Darini1. 1Faculdade de Cieˆncias
Farmaceˆuticas de Ribeira˜o Preto − Universidade de Sa˜o Paulo, Ribeira˜o Preto,
Brazil; 2Hospital das Clı´nicas da Faculdade de Medicina de Ribeira˜o Preto-
Universidade de Sa˜o Paulo, Departamento de Puericultura e Pediatria, Ribeira˜o
Preto, Brazil; 3Hospital das Clı´nicas da Faculdade de Medicina de Ribeira˜o
Preto-Universidade de Sa˜o Paulo, Laborato´rio de Microbiologia, Ribeira˜o Preto,
Brazil
Chronic lung infection by A. xylosoxidans may lead to rapid clinical deteriora-
tion in cystic ﬁbrosis patients (CFP). A. xylosoxidans is intrinsically resistant to
cephalothin, cefoxitin, cefotaxime, aztreonam and aminoglycosides. The pattern of
transmission of A. xylosoxidans from patient to patient is not fully understood. The
purpose of this study was to evaluate the frequency of infection by A. xylosoxidans
in CFP under treatment in a hospital in Brazil, the antimicrobial susceptibility and
possible clonal similarity between the strain, correlating results with clinical data.
During September 2011/2013, isolates were identiﬁed by PCR and biochemical
tests. The MIC of antimicrobial activity was performed in accordance with CLSI.
The macrorestriction proﬁle was analyzed by PFGE (XbaI). From 106 patients, 7.5%
showed two or more cultures with A. xylosoxidans. Their mean age was 18 years,
BMI was around 19 and the Shwachman score was 50. However, lung function was
very low with the means of FVC= 1.76 L and FEV1= 1.06 L, and one girl died.
Although controversial, two brothers showed the same macrorestriction proﬁle and
three other patients, without kinship, showed equal pulsotype. All of these patients
showed colonization for other bacteria including P. aeruginosa, S. aureus and Bcc.
A. xylosoxidans was 100% sensitive to imipenem, 81.8% to meropenem, 72.7% to
piperacillin–tazobactam, 63.6% to ceftazidime, 54.5% to polymyxin B and 9% to
ciproﬂoxacin. In conclusion, our group of patients with A. xylosoxidans showed
a very compromised lung function and low Shwachman score without nutritional
impairment, whereas bacteria showed a similar sensibility proﬁle to literature.
107 Time trends in clinical indicators for cystic ﬁbrosis (CF) patients
at transition to adult care
H.K. Sandhu1, J. Geake1, S.C. Bell1. 1Adult Cystic Fibrosis Centre, The Prince
Charles Hospital, Brisbane, Australia
Objectives: To investigate whether respiratory infection in CF patients transitioning
to adult care changed over 14 years.
Methods: All CF patients transitioning from paediatric care to TPCH CF Centre
in Brisbane, over three time periods: 2000–2004, 2005–2009 and 2010–2013, were
included. All sputum samples referred for microbiological analysis in Queensland
in the 12 months prior to and after the date of transition were identiﬁed from a
statewide pathology database. Rates of Pseudomonas infection, lung function and
BMI were analysed with univariate analyses. Gender, location of paediatric care,
Pseudomonas isolation at transition, and the number of sputum samples analysed
were included in the multivariate analysis.
Results: 187 patients were identiﬁed. Over the three time points, the percentage of
patients with Pseudomonas was 90.8%, 78.9%, and 72.2% respectively (p = 0.021).
There were trends towards improvements in BMI, FEV1 % predicted, and FVC %
predicted. These trends were accounted for by the rate of Pseudomonas infection
and number of sputum samples referred.
Conclusion: Improvements in lung function and nutrition in CF patients transi-
tioning to adult care between 2000 and 2013 are associated with a reduction in
rates of Pseudomonas infection, and a reduction in the number of sputa referred
for microbiology. This raises the possibility that the improved health of CF patients
is as a consequence of reduced rates of Pseudomonas infection at the time of
transition.


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107 Time trends in clinical indicators for cystic fibrosis (CF) patients at transition to adult care

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