Analysis of factors associated with the development of tobramycin (TO) resistance in Cystic Fibrosis (CF) patients

W. Stratbucker, John Louis Colombo, T. Hallberg, Paul Henry Sammut

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Abstract

PURPOSE: Emergence of aminoglycoside-resistant stains of gram-negative bacteria in CF patients is a disturbing finding which may be associated with rapid pulmonary deterioration. The purpose of this study was to help determine what factors precede infection with TO-resistant (TR) gram negative bacteria. METHODS: Eleven CF patients with TR bacterial infection were identified, 8 with Pseudomonas aeruginosa, two with Pseudomonas cepacia, and one with Xanthamonas maltophilia. A case-control group was chosen with matching by age, lung severity (FVC and FEV1 values) and, in all but one case, by sex. All patients were identified by retrospective chart review. The date of first positive culture for TR organism, and corresponding date for the case-controls, served as the end point for a 12-month time period in which treatment data were analyzed for both groups. Variables analyzed included days hospitalized, days of intravenous (IV) antibiotics, days of IV TO, days of oral Ciprofloxacin (CP), days of oral antibiotics excluding CP, days of aerosolized antibiotics, and days of aerosolized TO. Student's t-test was used to compare the data. If values were non-parametric, a Mann-Whitney Rank Sum test was used. RESULTS: There was a significant difference between the case and control groups only in the number of days of aerosolized TO (P=.031, Mann-Whitney). The difference in days of IV TO approached significance (P=.054, Mann-Whitney). CONCLUSIONS: In this small group of patients, the data suggests that the use of aerosolized TO is closely associated with the development of TR gram-negative bacterial infection in CF. CLINICAL IMPLICATIONS: The risk of developing TR with use of aerosolized TO in CF patients should be considered when using this mode of therapy.

Original languageEnglish (US)
Pages (from-to)155S
JournalChest
Volume110
Issue number4 SUPPL.
Publication statusPublished - Oct 1 1996

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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