PURPOSE: The U.S. Cystic Fibrosis Foundation (CFF) has developed guidelines for the culturing of sputum obtained from patients with CF. These CFF protocol cultures (CF cultures) are more extensive than standard sputum cultures; they include the use of selective media for Staphyloccus aureus, Haemophilus influenzae and Burkholderia cepacia, prolonged incubation of specimens, and agar-based diffusion assays for susceptibility testing of Pseudomonas aeruginosa. We sought to evaluate the use of CF cultures for patients who do not have CF (non-CF patients).
METHODS: 757 pulmonologists who practice at 67 U.S. tertiary care centers were surveyed between August 2009 and April 2010. A commercial, web-based survey tool was used to obtain data on the use of CF cultures for non-CF patients.
RESULTS: Responses were obtained from 265/757 (35%) pulmonologists at 59/67 (88%) centers. Overall, 216/265 (83%) respondents see < 10% CF patients in their practice. Of the 265 respondents, 113 (44%) obtain CF cultures for non-CF patients. Of these, 112/113 (99%) obtain CF cultures for non-CF bronchiectasis, 8/113 (7%) obtain CF cultures for COPD exacerbations, 4/113 (4%) obtain CF cultures for lung transplant patients and 3/113 (3%) obtain CF cultures for community-acquired pneumonia. Of those who order CF cultures for non-CF bronchiectasis,103/112 (93%) use the results to guide antibiotic therapy during exacerbations, 42/112 (38%) use the results to guide antibiotic therapy during surveillance periods, 37/112 (33%) use the results for infection control purposes, and 17/112 (15%) use the results to determine disease severity and prognosis.
CONCLUSION: Pulmonologists are utilizing CF cultures for non-CF patients--mostly patients with non-CF bronchiectasis--and are using the culture results to guide antibiotic therapy.
CLINICAL IMPLICATIONS: The use of CF cultures to guide antibiotic therapy in non-CF bronchiectasis has not been correlated with clinical outcomes; further studies to address this issue are needed. Additionally, the practice of using CF cultures for non-CF patients may distort the reported prevalence of respiratory tract bacteria and antimicrobial resistance in the CF population.
DISCLOSURE: Jennifer Brown, No Financial Disclosure Information; No Product/Research Disclosure Information