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Antimicrobial resistance in cystic fibrosis: a Delphi approach to defining best practices

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Title: Antimicrobial resistance in cystic fibrosis: a Delphi approach to defining best practices
Authors: Zemanick, E
Burgel, P-R
Taccetti, G
Holmes, A
Ratjen, F
Byrnes, CA
Waters, VJ
Bell, SC
VanDevanter, DR
Stuart Elborn, J
Flume, PA
Antimicrobial Resistance International Working Group in Cystic Fibrosis
Item Type: Journal Article
Abstract: BACKGROUND: Antimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community. METHODS: We engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing. RESULTS: Consensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results. CONCLUSIONS: Recommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.
Issue Date: 31-Oct-2019
Date of Acceptance: 2-Oct-2019
URI: http://hdl.handle.net/10044/1/75567
DOI: 10.1016/j.jcf.2019.10.006
ISSN: 1569-1993
Publisher: Elsevier
Start Page: 370
End Page: 375
Journal / Book Title: Journal of Cystic Fibrosis
Volume: 19
Issue: 3
Copyright Statement: © 2019 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: NF-SI-0617-10176
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
Cystic fibrosis
Antimicrobial resistance
Antimicrobial resistance
Cystic fibrosis
Antimicrobial Resistance International Working Group in Cystic Fibrosis
Antimicrobial resistance
Cystic fibrosis
Respiratory System
1103 Clinical Sciences
Publication Status: Published
Conference Place: Netherlands
Online Publication Date: 2019-10-31
Appears in Collections:Department of Infectious Diseases
National Heart and Lung Institute
Faculty of Medicine