Methicillin-resistant Staphylococcus aureus in Cystic Fibrosis: impact, management and the use of the Multiple-Breath Washout Test in monitoring after therapeutic interventions

Abstract

With increasing survival due to improvements of care, we are now faced to
new challenges in the care for Cystic Fibrosis patients. An increased
frequency of pulmonary infections with new and resistant pathogens like
methicillin-resistant S aureus (MRSA) has been identified and innovative and
more sensitive tools for monitoring lung function in early CF lung disease
and after therapeutic interventions are under study. In this work we have
indicated that chronic infection with MRSA can have a negative impact on
the clinical status of CF patients with a more rapid decline of FEV1 after
acquisition of MRSA. Based on these results we conducted an eradication
protocol for patients chronically colonized with MRSA leading to successful
microbiological eradication in all eleven patients. With the Multiple-Breath
Washout Test (MBW test) we currently have an innovative tool for
monitoring pulmonary function in Cystic Fibrosis. From the MBWtest we can
derive the Lung Clearance Index, a marker of global ventilation
inhomogeneity, but also separate the different compounds contributing to
ventilation distribution, using the normalised phase III slope analysis. In this
manuscript we studied the use of this ventilation distribution test in
advanced adult CF lung disease. We were able to show that in CF patients in
whom an improvement in LCI was obtained after treatment for an acute
infectious exacerbation, this was paralleled by a decrease of acinar
ventilation heterogeneity. We also used the MBW test to monitor lung
volumes and gas trapping after MRSA eradication. The ability to perform this
test in all age groups makes it a true useful test for longitudinal evaluation
of lung function from infancy into adulthood, and for follow-up after
therapeutic interventions.

Date of Award	4 Mar 2015
Original language	English
Awarding Institution	Vrije Universiteit Brussel
Supervisor	Walter Vincken (Promotor), Anne Malfroot (Co-promotor), Brigitte Velkeniers-Hoebanckx (Promotor), Anne Naessens (Jury), Iris De Schutter (Jury), Sabine Allard (Jury), H. Tiddens (Jury), Christiane Knoop (Jury) & L. Dupont (Jury)