Chronic cough, airway obstruction, and infections that come and go and cause damage to the bronchi and bronchioles are characteristic of bronchiectasis, leaving people with this disease susceptible to serious infections with bacterial pathogens and fungal microbes.
Among the most common bacterial pathogens isolated in bronchiectasis are Haemophilus influenzae, a bacteria that can cause problems ranging from ear infections and bronchitis to pneumonia, and Pseudomonas aeruginosa, which can cause of variety of respiratory infections, including pneumonia, and severe systemic infections. About one-third of bronchiectasis patients are known to have chronic P. aeruginosa infections.
P. aeruginosa is a gram-negative bacteria, meaning that it is resistant to many medicines and increasingly resistant to available antibiotics. Found in moist locations, such as soil and water, it is an opportunistic pathogen, taking advantage of weakened immune defenses and, in people bronchiectasis or cystic fibrosis, excessive mucus accumulation and poor lung function. The bacteria has a tendency to persist in bronchiectatic airways, due to its ability to produce virulence factors and modulate immune defences by quorum signaling and biofilm production.
People with bronchiectasis and P. aeruginosa infection are known to have a lower quality of life than those with other bacterial infections, and are at risk of an accelerated decline in lung function and more frequent exacerbations or flares. Treatment, because of the pathogen’s growing resistance to antibiotics, can be difficult.
Treating Pseudomonas aeruginosa lung infections
Overuse of antibiotics is a leading reason for Pseudomonas aeruginosa resistance, and the British Thoracic Society has published best-practice guidelines for the treatment of P. aeruginosa infections in people with non-CF bronchiectasis. According to these guidelines, oral ciprofloxacin is a preferred treatment for a first infection, and intravenous treatment is to be considered for people who do respond. Resistant strains of this bacteria likely require combination antibiotic treatment, including ciprofloxacin, and combinations are recommended for bronchiectasis patients who “will require many subsequent antibiotic courses to reduce the development of drug resistance.”
Nebulized colistin is also a potential treatment for this infection.
The American Thoracic Society also recommends a combination antibiotic treatment that includes aminoglycosides, ticarcillin, ceftazidime, cefepime, aztreonam, ciprofloxacin and levofloxacin, with selection based on such considerations as the severity of the infection, underlying risk factors, and other (co-morbid) illnesses in a patient. Delays in treating P. aeruginosa infections are linked to serious outcomes, including a higher risk of death, even in stable patients.
A retrospective study examined antibiotic resistance in 168 people with pneumonia caused by P. aeruginosa, and found the bacteria least resistant to treatment with colistin, although this bacteria is highly adaptive.
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