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Ann Am Thorac Soc
2014[Oct]; 11
(8
): 1298-306
PMID25167882
show ga
Airway infections are a key component of cystic fibrosis (CF) lung disease.
Whereas the approach to common pathogens such as Pseudomonas aeruginosa is guided
by a significant body of evidence, other infections often pose a considerable
challenge to treating physicians. In Part I of this series on the antibiotic
management of difficult lung infections, we discussed bacterial organisms
including methicillin-resistant Staphylococcus aureus, gram-negative bacterial
infections, and treatment of multiple bacterial pathogens. Here, we summarize the
approach to infections with nontuberculous mycobacteria, anaerobic bacteria, and
fungi. Nontuberculous mycobacteria can significantly impact the course of lung
disease in patients with CF, but differentiation between colonization and
infection is difficult clinically as coinfection with other micro-organisms is
common. Treatment consists of different classes of antibiotics, varies in
intensity, and is best guided by a team of specialized clinicians and
microbiologists. The ability of anaerobic bacteria to contribute to CF lung
disease is less clear, even though clinical relevance has been reported in
individual patients. Anaerobes detected in CF sputum are often resistant to
multiple drugs, and treatment has not yet been shown to positively affect patient
outcome. Fungi have gained significant interest as potential CF pathogens.
Although the role of Candida is largely unclear, there is mounting evidence that
Scedosporium species and Aspergillus fumigatus, beyond the classical presentation
of allergic bronchopulmonary aspergillosis, can be relevant in patients with CF
and treatment should be considered. At present, however there remains limited
information on how best to select patients who could benefit from antifungal
therapy.
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