Antimicrobial Resistance in Cystic Fibrosis (CF)

February 6, 2009 updated by: Seattle Children's Hospital

Antimicrobial Resistance in Sputum Obtained From Patients With Cystic Fibrosis (CF)

People with cystic fibrosis (CF) often develop chronic pulmonary infections which are caused by a variety of organisms, the most predominant being Pseudomonas aeruginosa. Antibiotics are important in managing CF lung infections. Antibiotic use in CF was altered about ten years ago with the approval of inhaled tobramycin, an aminoglycoside which is effective in treating P. aeruginosa. A decade later, CF clinicians are increasingly concerned about the likelihood of induction of aminoglycoside-resistance with prolonged use of inhaled tobramycin to treat chronic P. aeruginosa airway infections. The goal of this study is to examine the current microbiology and susceptibility of organisms from CF sputum, correlate it with antibiotic use, and compare it with previous data.

Study Overview

Status

Completed

Conditions

Detailed Description

Aminoglycosides are one of the mainstays of antibiotic therapy in CF. They are administered parenterally in synergistic combinations with β-lactam antibiotics for acute exacerbations and used by inhalation as single agents for chronic maintenance therapy. It is well known in CF and other chronic infections that chronic use of antibiotics results in resistance. Thus, the increasing use of aminoglycosides could have dramatically changed the microbiological epidemiology of CF, since it was last examined a decade ago. It will be important to determine the current prevalence of antibiotic resistance in CF pathogens. Current antimicrobial strategies may also be contributing to the increased rate of isolation of novel and difficult to treat organisms, including intrinsically antibiotic-resistant bacteria. These issues are important both for CF clinicians and for researchers developing new antimicrobials to be used in CF.

To determine if the prevalence of P. aeruginosa resistance and the prevalence of other CF pathogens has changed over the past ten years, this multi-center cross-sectional study will enroll a contemporary cohort of patients with CF and will compare their sputum microbiology and susceptibility data with corresponding baseline data from an historical cohort consisting of patients enrolled in the prior phase 3 trials of inhaled tobramycin, conducted by PathoGenesis Corporation. (A Phase III Placebo Controlled Clinical Trial (PC-TNDS-002) to Study the Safety and Efficacy of Tobramycin in Inhalation in Patients with Cystic Fibrosis). The data set from the phase 3 trials which will be used for this research project will be anonymous.

This current study will be coordinated by the CF research team at CHRMC and aims to enroll 520 patients at approximately 50 participating sites across the United States. The contemporary cohort will include patients with CF who are ages 6 years and older and able to expectorate sputum. Patients will be enrolled from many of the same CF centers that participated in the phase 3 trials of inhaled tobramycin, and eligibility criteria will be similar to those used in the phase 3 trials. Subjects enrolled in the contemporary cohort will have a single study visit to obtain a sputum sample that will be sent to a central laboratory for culture and susceptibility testing.

Study Type

Observational

Enrollment (Actual)

304

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Washington
      • Seattle, Washington, United States, 98105
        • Children's Hospital and Regional Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

6 years and older (Child, Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Children and young adults with cystic fibrosis

Description

Inclusion Criteria:

  • > 6 years of age.
  • Documented sweat chloride greater than 60 mEq/mL by quantitative pilocarpine iontophoresis test or homozygous for deltaF508 genetic mutation (or heterozygous for two well-characterized mutations) and one or more clinical features consistent with CF.
  • Most recent FEV1 between 25% and 75% predicted when clinically stable; must be obtained at or within 3 months prior to study visit.
  • P. aeruginosa present in the most recent sputum or throat culture obtained within 6 months prior to study visit.
  • Able to expectorate sputum on a routine basis.
  • Written informed consent provided.

Exclusion Criteria:

  • Administration of any anti-pseudomonal antibiotics by any route within 14 days prior to study visit.
  • Participation in a research protocol that potentially involves antibiotic treatment within 14 days prior to study visit.
  • Requiring treatment with intravenous or inhaled anti-pseudomonal antibiotics at study visit.
  • B. cepacia complex present in the most recent sputum or throat culture obtained within 6 months prior to study visit.
  • Post lung transplantation.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Seattle Children's Hospital

Collaborators

Cystic Fibrosis Foundation

Investigators

  • Principal Investigator: Jane L Burns, MD, University of Washington and Children's Hospital and Regional Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2006

Study Completion (Actual)

June 1, 2008

Study Registration Dates

First Submitted

August 2, 2006

First Submitted That Met QC Criteria

August 2, 2006

First Posted (Estimate)

August 4, 2006

Study Record Updates

Last Update Posted (Estimate)

February 10, 2009

Last Update Submitted That Met QC Criteria

February 6, 2009

Last Verified

February 1, 2009

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BURNS04A0

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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