What Spanish consensus meant for the treatment of Pseudomonas aeruginosa infection in patients with cystic fibrosis in the initial lung infection?

array:24 ["pii" => "S2387020620300589" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.08.006" "estado" => "S300" "fechaPublicacion" => "2020-03-27" "aid" => "5020" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2020;154:232-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775319306190" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.08.006" "estado" => "S300" "fechaPublicacion" => "2020-03-27" "aid" => "5020" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2020;154:232-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "Artículo especial" "titulo" => "¿Qué supuso el consenso español para el tratamiento de la infección por Pseudomonas aeruginosa en pacientes con fibrosis quística en la infección pulmonar inicial?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "232" "paginaFinal" => "235" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "What Spanish consensus meant for the treatment of Pseudomonas aeruginosa infection in patients with cystic fibrosis in the initial lung infection?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 803 "Ancho" => 1532 "Tamanyo" => 57803 ] ] "descripcion" => array:1 [ "es" => "Pregunta 3 de la encuesta: ¿Cuál es la estrategia de tratamiento tras el primer fallo en la erradicación de la primoinfección por Pseudomonas aeruginosa? (ordenar estrategias 1.ª a 5.ª, según su práctica clínica)." ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Concepción Prados, Ester Zamarrón, Rosa Girón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Concepción" "apellidos" => "Prados" ] 1 => array:2 [ "nombre" => "Ester" "apellidos" => "Zamarrón" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Girón" ] 3 => array:1 [ "colaborador" => "en representación del Grupo de trabajo de Jornadas Ayre-Consenso español" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Grupo de trabajo Jornadas Ayre-Consenso español" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620300589" "doi" => "10.1016/j.medcle.2019.08.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300589?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319306190?idApp=UINPBA00004N" "url" => "/00257753/0000015400000006/v1_202003130649/S0025775319306190/v1_202003130649/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620300383" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.11.036" "estado" => "S300" "fechaPublicacion" => "2020-03-27" "aid" => "4701" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;154:236-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Scientific letter" "titulo" => "Epidemiological analysis of the Chilean national registry of cutaneous T-cell lymphomas, years 2006–2012" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "236" "paginaFinal" => "237" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epidemiologia del linfoma cutáneo primario de células T en Chile: años 2006-2012" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Arellano, María Paz Salinas, María Irene Araya" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Arellano" ] 1 => array:2 [ "nombre" => "María Paz" "apellidos" => "Salinas" ] 2 => array:2 [ "nombre" => "María Irene" "apellidos" => "Araya" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775318307280" "doi" => "10.1016/j.medcli.2018.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318307280?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300383?idApp=UINPBA00004N" "url" => "/23870206/0000015400000006/v1_202003210833/S2387020620300383/v1_202003210833/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020620300450" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.09.002" "estado" => "S300" "fechaPublicacion" => "2020-03-27" "aid" => "5027" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2020;154:221-31" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Review" "titulo" => "Hip fracture mortality: Predictive models" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "231" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad tras fractura de cadera: modelos predictivos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Pallardo Rodil, Javier Gómez Pavón, Pablo Menéndez Martínez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Pallardo Rodil" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Gómez Pavón" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Menéndez Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319306335" "doi" => "10.1016/j.medcli.2019.09.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319306335?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300450?idApp=UINPBA00004N" "url" => "/23870206/0000015400000006/v1_202003210833/S2387020620300450/v1_202003210833/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "What Spanish consensus meant for the treatment of Pseudomonas aeruginosa infection in patients with cystic fibrosis in the initial lung infection?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "232" "paginaFinal" => "235" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Concepción Prados, Ester Zamarrón, Rosa Girón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Concepción" "apellidos" => "Prados" "email" => array:1 [ 0 => "mconcepcion.prados@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ester" "apellidos" => "Zamarrón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rosa" "apellidos" => "Girón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:2 [ "colaborador" => "on behalf of the Ayre Conference-Spanish Consensus Working Group" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "◊" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidades de Fibrosis Quística y Bronquiectasias, Servicios de Neumología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Fibrosis Quística, Servicio de Neumología, Hospital de La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué supuso el consenso español para el tratamiento de la infección por Pseudomonas aeruginosa en pacientes con fibrosis quística en la infección pulmonar inicial?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 780 "Ancho" => 2906 "Tamanyo" => 134618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Second question of the survey: How many eradication attempts are carried out in the same patient consecutively before considering a chronic Pseudomonas aeruginosa colonization? inhAB: inhaled antibiotic; ivAB: intravenous antibiotic." ] ] ] "textoCompleto" => "IntroductionCystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the gene that encodes the transmembrane conductivity regulatory protein in CF or the CFTR gene. The involvement of the chlorine channel in the apical membrane of the secretory cells favours bronchial infection caused by potentially pathogenic microorganisms (PPM), such as Pseudomonas aeruginosa.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Current records show that chronic bronchitis (CB) due to P. aeruginosa is estimated at 13% in <18 years of age and 38.4% in >18 years of age (unpublished data from the Spanish registry). This infection has been associated with deterioration of lung function, growth abnormalities, increased respiratory exacerbations and, ultimately, reduced survival.<a class="elsevierStyleCrossRefs" href="#bib0015">3–6</a>Three phases are differentiated in respiratory infection due to P. aeruginosa in CF<a class="elsevierStyleCrossRefs" href="#bib0035">7–9</a>: 1) First infection or initial infection, when P. aeruginosa is detected in culture for the first time. The goal of therapy is eradication, achieving high rates if treatment is applied early.<a class="elsevierStyleCrossRefs" href="#bib0050">10–12</a> According to the national consensus published in 2015,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> it is considered eradicated when you get at least 2 negative cultures 1–2 weeks after finishing the treatment and at least 2–4 weeks apart from each other; 2) Intermittent infection, when positive and negative cultures are obtained intermittently after the initial infection. It may be due to multiple causes, including low levels of infection, heterogeneity of the samples or persistent colonization in sinuses, among others<a class="elsevierStyleCrossRef" href="#bib0070">14</a>; 3) Chronic infection, when the cultures are persistently positive, with no new clinical signs of infection and with possible inflammatory response, and 4) Exacerbations, with the onset or increase of respiratory symptoms during the course of the disease.The treatment of choice to fight infection due to P. aeruginosa is the inhaled route, associated or not with oral or intravenous antibiotic therapy.<a class="elsevierStyleCrossRefs" href="#bib0065">13,15–19</a> The combination with other medications will depend on the patient's signs and symptoms and any complementary examinations.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>In 2015, a group of experts published the first consensus on the diagnosis and treatment of bronchial infection due to P. aeruginosa in CF according to grades of evidence (I-III),<a class="elsevierStyleCrossRef" href="#bib0105">21</a> weighing the strength of recommendation according to clinical experience (A–D).<a class="elsevierStyleCrossRef" href="#bib0065">13</a>This study includes the analysis of 2 surveys carried out in the national CF departments: one was carried out prior to the publication of the consensus and another one a year after its publication, in order to assess how the diagnosis and treatment of the initial bronchial infection due to this microorganism in routine care practice was carried out, and the impact that the consensus had on them.Patients and methodsAn initial survey was carried out by the Spanish Society of Cystic Fibrosis (SEFQ, for its acronym in Spanish) in January 2015 in order to evaluate routine care practices in the diagnosis and treatment of bronchial infection due to P. aeruginosa in CF in all Spanish multidisciplinary departments. Later, in January 2016, the survey was submitted again to the same departments, one year after the consensus was published,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> to evaluate whether this practice had changed in relation to the recommendations made.ResultsDistribution of the participantsFirst survey22 surveys were sent via e-mail through a link to the same number of Spanish departments and a total of 10 departments responded (45%).Second survey22 surveys were sent via e-mail through a link to the same number of Spanish departments and a total of 9 (42.5%) responded.Survey results<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Mean age of patients at the time of initial P. aeruginosa infection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia></li></ul>As shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, the most common mean ages in 2015 were 1–5 years (55%) and 6–11 years (36%). Although the same mean ages continued during the following year, the percentages varied to 69% and 15%, respectively.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010">•Number of consecutive eradication attempts in the same patient before considering chronic colonization due to P. aeruginosa (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia></li></ul>The results have been very similar in the 2 surveys, so that 50% repeated eradication attempts up to 3 times.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015">•Treatment strategy after the first failure to eradicate the initial P. aeruginosa infection (order 1 st to 5th strategies, according to clinical practice) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia></li></ul>The 5 possible strategies proposed in the survey were the following: 1) increase the dose or treatment time of the previously used inhaled antibiotic; 2) previously used inhaled antibiotic + intravenous antibiotic; 3) change of inhaled antibiotic; 4) change of inhaled antibiotic + intravenous antibiotic, and 5) previously used inhaled antibiotic + new inhaled antibiotic.If we compare both surveys, we found that before the consensus either an intravenous antibiotic was added to the previous inhaled treatment (42%) or the previous inhaled antibiotic dose/treatment time was increased (42%). A year later the response was that, after the first therapeutic failure, a change of inhaled antibiotic (50%) was preferred.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0020">•Treatment strategy after the second therapeutic failure in the eradication of the initial P. aeruginosa infection (order 1 st to 4th strategies, according to clinical practice) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia></li></ul>In the 2016 survey, 54% of the centres made a change of inhaled antibiotic when faced with the second therapeutic failure. Before the consensus, in 2015, although the first-choice strategy was the same as in 2016, the implementation percentage was significantly lower (33%).The second strategy most used by the centres in 2016 was to either add intravenous antibiotics to the previously used inhaled treatment (38%) or opt for an inhaled therapeutic change (33%). Before the consensus, in 2015, an increase in dose/time of the treatment or a change of inhaled antibiotic was chosen in the same percentage (33%).Discussion<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0025">•Average age of patients at the time of initial P. aeruginosa infection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</li></ul>These data clearly showed the rapid decrease in the age of the initial P. aeruginosa infection, probably due to neonatal screening, which has had a significant impact in the early diagnosis of bronchial infections. Our data are similar to those published in a cohort study conducted in the USA a few years ago, in which a median age of one year was recorded for initial P. aeruginosa infection with a non-mucoid phenotype, showing infection in almost one third (29%) of patients under 6 years of age; the identification of P. aeruginosa with mucoid phenotype was observed in patients between 4 and 16 years of age (median of 13 years).<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Results of a study carried out in Australia showed that the median age of initial P. aeruginosa infection in children with CF was 2.31–3.10 years. This study showed that the risk was geographic location-dependent.<a class="elsevierStyleCrossRef" href="#bib0110">22</a><ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0030">•Number of consecutive eradication attempts in the same patient before considering chronic P. aeruginosa colonization (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</li></ul>Regarding this issue, the 2015 Spanish consensus recognized that there was no conclusive data on the number of times that eradication cycles should be repeated after a first failure, and recommended, in case of a second therapeutic failure, to try changes in inhaled antibiotics or administration of intravenous antibiotics, at least once more.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>According to the survey carried out in 2016, most of the centres (54%) reported that they carried out up to 3 eradication attempts before considering a bronchial P. aeruginosa infection as chronic. Regarding this point, no significant differences were observed in the procedures followed by the different centres with respect to what was done before the consensus was published.According to European quality standards, there is no clear evidence on treatment onset regarding the initial infection, although the authors recommend not exceeding 4 weeks after microbiological results. They also specify that there is no superiority of one treatment over another, although they incorporate the inhaled antibiotic treatment from the beginning.<a class="elsevierStyleCrossRefs" href="#bib0115">23,24</a><ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0035">•Treatment strategy after a first failure to eradicate an initial P. aeruginosa infection (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</li></ul>It should be mentioned that, although there are different protocols for the eradication of P. aeruginosa infection, none has shown superiority over another.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15,25,26</a> Regarding this issue, it seems that the Spanish consensus has helped to unify treatment criteria and has also contributed to make earlier decisions concerning therapeutic changes, regardless of the regimens used, which obviously depend on the experience of each department.<a class="elsevierStyleCrossRef" href="#bib0065">13</a><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0040">•Treatment strategy after a second therapeutic failure in the eradication of the initial P. aeruginosa infection (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</li></ul>In Europe, according to data from a survey conducted among 547 CF centres from 32 countries in which Spain was included, 96% of these centres conducted routine sensitivity studies for decision-making regarding the prescription of antibiotics. 94% prescribed treatment based on the results of these in vitro analyses. 83% changed according to an antimicrobial susceptibility profile with the objective of improving or stabilizing lung function and only 14% saw the eradication of the infection as the primary objective.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>On the other hand, in 84% of the cases, the initial P. aeruginosa infection was treated with antibiotics, mainly nebulized. However, it is striking that a significant percentage of respondents stated that they did not use antibiotics until P. aeruginosa had been repeatedly isolated (59%) or before lung function (41%) deterioration. The most common antibiotic strategies included nebulized colistin in combination with oral ciprofloxacin (43%) and nebulized tobramycin (41%). 34% reported to use treatment with oral ciprofloxacin alone. Only 1% of the centres used prophylactic therapy for bronchial P. aeruginosa infection at the time of CF diagnosis.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>The Cystic Fibrosis Foundation in the US recommends the use of inhaled antibiotics for the treatment of initial P. aeruginosa infection or new growths of it. The recommended antibiotic regimen is inhaled tobramycin in on-off cycles of 28 days. As in Europe, the use of prophylactic therapy against P. aeruginosa infection is not recommended due to proven absence of clinical benefit.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>In our surveyed centres, although the performance was similar in the 2 surveys, the type of nebulized antibiotic changed from 33% to 54% after the publication of the consensus. In the second survey, up to 38% of cases considered adding an IV antibiotic, a possibility chosen in a smaller percentage in the previous year.ConclusionsAs conclusions of the data evaluated in this survey on the adherence of the different national CF departments to the Spanish consensus for the diagnosis and treatment of initial P. aeruginosa infection in patients with CF, we can point out the following:<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0045">•A decrease in age has been observed in the diagnosis of initial P. aeruginosa infection in children, probably due to neonatal screening.</li><li class="elsevierStyleListItem" id="lsti0050">•We believe that the consensus has helped to unify treatment criteria, and also to make earlier decisions regarding therapeutic changes, regardless of the therapeutic regimens used, which obviously depend on the experience of each unit.</li></ul>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Distribution of the participants" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "First survey" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Second survey" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Survey results" ] ] ] ] ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "xack455357" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-03" "fechaAceptado" => "2019-08-26" "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Prados C, Zamarrón E, Girón R, en representación del Grupo de trabajo de Jornadas Ayre-Consenso español. ¿Qué supuso el consenso español para el tratamiento de la infección por Pseudomonas aeruginosa en pacientes con fibrosis quística en la infección pulmonar inicial?. Med Clin (Barc). 2020;154:232–235." ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "Members of the Ayre Conference-Spanish Consensus Working Group can be found in the Appendix A." "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "☆☆" "nota" => "The surveys were presented at the Ayre Conference for cystic fibrosis, sponsored by the Gilead laboratory. The laboratory did not influence the surveys, which were sent anonymously to the Spanish departments through the Spanish Society for Cystic Fibrosis." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "Esther Quintana (Hospital Virgen del Rocío), Luis Máiz y Rosa Nieto (Hospital Ramón y Cajal), Óscar Asensio (Hospital Parc Taulí), Rodolfo Álvarez-Sala, Sarai Quirós, María Martínez-Redondo, Alberto Mangas (Hospital Universitario La Paz) y Teresa Martínez-Martínez (Hospital Universitario Doce de Octubre)." "etiqueta" => "Appendix A" "titulo" => "Ayre Conference-Spanish Consensus Working Group" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 951 "Ancho" => 2903 "Tamanyo" => 155227 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Answer to the 1st question: What is the average age of your patients at the time of initial Pseudomonas aeruginosa colonization? inhAB: inhaled antibiotic; ivAB: intravenous antibiotic." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 780 "Ancho" => 2906 "Tamanyo" => 134618 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Second question of the survey: How many eradication attempts are carried out in the same patient consecutively before considering a chronic Pseudomonas aeruginosa colonization? inhAB: inhaled antibiotic; ivAB: intravenous antibiotic." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 803 "Ancho" => 1503 "Tamanyo" => 56904 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Third question of the survey: What is the treatment strategy after the first failure to eradicate an initial Pseudomonas aeruginosa infection? (Order 1st to 5th strategies, according to your clinical practice)." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 976 "Ancho" => 2143 "Tamanyo" => 104451 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Answer to question #4 of the survey: What is the treatment strategy after the second therapeutic failure in the eradication of the initial Pseudomonas aeruginosa infection? (order 1st to 4th strategies, according to your clinical practice). FEV1: forced expiratory volume in the first second." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence for periciliary liquid layer depletion, not abnormal ion composition, in the pathogenesis of cystic fibrosis airways disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Matsui" 1 => "B.R. Grubb" 2 => "R. Tarran" 3 => "S.H. Randell" 4 => "J.T. Gatzy" 5 => "C.W. Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0092-8674(00)81724-9" "Revista" => array:6 [ "tituloSerie" => "Cell" "fecha" => "1998" "volumen" => "95" "paginaInicial" => "1005" "paginaFinal" => "1015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9875854" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.M.1 Nixon" 1 => "D.S. Armstrong" 2 => "R. Carzino" 3 => "J.B. Carlin" 4 => "A. Olinsky" 5 => "C.F. Robertson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatric" "fecha" => "2001" "volumen" => "138" "paginaInicial" => "699" "paginaFinal" => "704" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Emerson" 1 => "M. Rosenfeld" 2 => "S. McNamara" 3 => "B. Ramsey" 4 => "R.L. Gibson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.10127" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2002" "volumen" => "34" "paginaInicial" => "91" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12112774" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Longitudinal development of mucoid Pseudomonas aeruginosa infection and lung disease progression in children with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Li" 1 => "M.R. Kosorok" 2 => "P.M. Farrell" 3 => "A. Laxova" 4 => "S.E. West" 5 => "C.G. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.293.5.581" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2005" "volumen" => "293" "paginaInicial" => "581" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15687313" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Baseline characteristics and factors associated with nutritional and pulmonary status at enrollment in the cystic fibrosis EPIC observational cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Rosenfeld" 1 => "J. Emerson" 2 => "S. McNamara" 3 => "K. Joubran" 4 => "G. Retsch-Bogart" 5 => "G.R. Graff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.21279" "Revista" => array:6 [ "tituloSerie" => "Pediatr Pulmonol" "fecha" => "2010" "volumen" => "45" "paginaInicial" => "934" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20597081" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.L. Brennan" 1 => "D.M. Geddes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00001432-200204000-00013" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Infect Dis" "fecha" => "2002" "volumen" => "15" "paginaInicial" => "175" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11964920" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial therapy for pulmonary pathogenic colonisation and infection by Pseudomonas aeruginosa in cystic fibrosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Canton" 1 => "N. Cobos" 2 => "J. de Gracia" 3 => "F. Baquero" 4 => "J. Honorato" 5 => "S. Gartner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2005.01217.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2005" "volumen" => "11" "paginaInicial" => "690" "paginaFinal" => "703" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16104983" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.W. Lee" 1 => "K.G. Brownlee" 2 => "S.P. Conway" 3 => "M. Denton" 4 => "J.M. Littlewood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1569-1993(02)00141-8" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2003" "volumen" => "2" "paginaInicial" => "29" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15463843" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluating the "Leeds criteria" for Pseudomonas aeruginosa infection in a cystic fibrosis centre" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Proesmans" 1 => "W. Balinska-Miskiewicz" 2 => "L. Dupont" 3 => "L. Dupont" 4 => "X. Bossuyt" 5 => "J. Verhaegen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00100805" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "937" "paginaFinal" => "943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16707392" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Taccetti" 1 => "S. Campana" 2 => "F. Festini" 3 => "M. Mascherini" 4 => "G. Doring" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.05.00009605" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "458" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16135728" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early antibiotic treatment for Pseudomonas aeruginosa eradication in patients with cystic fibrosis: a randomised multicentre study comparing two different protocols" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Taccetti" 1 => "E. Bianchini" 2 => "L. Cariani" 3 => "R. Buzzetti" 4 => "D. Costantini" 5 => "F. Trevisan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2011-200832" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "853" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22379071" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of early Pseudomonas aeruginosa infection in patients with cystic fibrosis: the ELITE trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Ratjen" 1 => "A. Munck" 2 => "P. Kho" 3 => "G. Angyalosi" 4 => "E.S. Group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.121657" "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2010" "volumen" => "65" "paginaInicial" => "286" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19996339" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Canton" 1 => "L. Maiz" 2 => "A. Escribano" 3 => "C. Olveira" 4 => "A. Oliver" 5 => "O. Asensio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2014.09.021" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "140" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614377" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of lung infection in patients with cystic fibrosis: current and future strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Doring" 1 => "P. Flume" 2 => "H. Heijerman" 3 => "J.S. Elborn" 4 => "G. Consensus Study" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2012.10.004" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2012" "volumen" => "11" "paginaInicial" => "461" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23137712" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.C. Langton Hewer" 1 => "A.R. Smyth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Syst Rev" "fecha" => "2009" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A network meta-analysis of the efficacy of inhaled antibiotics for chronic Pseudomonas infections in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.J. Littlewood" 1 => "K. Higashi" 2 => "J.P. Jansen" 3 => "G. apkun-Niggli" 4 => "M.M. Balp" 5 => "G. Doering" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2012.03.010" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2012" "volumen" => "11" "paginaInicial" => "419" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22717535" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Maiz" 1 => "R.M. Giron" 2 => "C. Olveira" 3 => "E. Quintana" 4 => "A. Lamas" 5 => "D. Pastor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Exp Opin Pharmacother" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "1135" "paginaFinal" => "1149" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.S. McCoy" 1 => "A.L. Quittner" 2 => "C.M. Oermann" 3 => "R.L. Gibson" 4 => "G.Z. Retsch-Bogart" 5 => "A.B. Montgomery" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Em J Respir Crit Care Med" "fecha" => "2008" "volumen" => "178" "paginaInicial" => "921" "paginaFinal" => "928" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.W. Ramsey" 1 => "M.S. Pepe" 2 => "J.M. Quan" 3 => "K.L. Otto" 4 => "A.B. Montgomery" 5 => "J. Williams-Warren" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199901073400104" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1999" "volumen" => "340" "paginaInicial" => "23" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9878641" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targeting airway inflammation in cystic fibrosis in children: past, present, and future" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Pressler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11588150-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Paediatr Drugs" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "141" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21500868" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Purpose of quality standards for infectious diseases. Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.A. Gross" 1 => "T.L. Barrett" 2 => "E.P. Dellinger" 3 => "P.J. Krause" 4 => "W.J. Martone" 5 => "J.E. McGowan Jr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/clinids/18.3.421" "Revista" => array:5 [ "tituloSerie" => "Clin infect Dis" "fecha" => "1994" "volumen" => "18" "paginaInicial" => "421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8011826" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geographical differences in first acquisition of Pseudomonas aeruginosa in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.C. Ranganathan" 1 => "B. Skoric" 2 => "K.A. Ramsay" 3 => "R. Carzino" 4 => "A.M. Gibson" 5 => "E. Hart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.201209-077OC" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2013" "volumen" => "10" "paginaInicial" => "108" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23607838" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Cystic Fibrosis society standards of care: best practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.R. Smyth" 1 => "S.C. Bell" 2 => "S. Bojcin" 3 => "M. Bryon" 4 => "A. Duff" 5 => "P. Flume" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2014.03.010" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "S23" "paginaFinal" => "S42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856775" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ECFS best practice guidelines: the 2018 revision" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Castellani" 1 => "A.J.A. Duff" 2 => "S.C. Bell" 3 => "H.G.M. Heijerman" 4 => "A. Munck" 5 => "F. Ratjen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2018.02.006" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2018" "volumen" => "17" "paginaInicial" => "153" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29506920" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eradication therapy for Pseudomonas aeruginosa colonization episodes in cystic fibrosis patients not chronically colonized by P. aeruginosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Schelstraete" 1 => "F. Haerynck" 2 => "S. Van daele" 3 => "S. Deseyne" 4 => "F. De Baets" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2012.07.008" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2013" "volumen" => "12" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22939202" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Cystic Fibrosis Society (ECFS). Available from: <a target="_blank" href="https://www.cff.org/Research/Researcher-Resources/Patient-Registry/2016-Patient-Registry-Annual-Data-Report.pdf">https://www.cff.org/Research/Researcher-Resources/Patient-Registry/2016-Patient-Registry-Annual-Data-Report.pdf</a>." ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Cystic Fibrosis Society Standards of Care: quality management in cystic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Stern" 1 => "D.P. Bertrand" 2 => "E. Bignamini" 3 => "M. Corey" 4 => "B. Dembski" 5 => "C.H. Goss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcf.2014.03.011" "Revista" => array:6 [ "tituloSerie" => "J Cyst Fibros" "fecha" => "2014" "volumen" => "13" "paginaInicial" => "S43" "paginaFinal" => "S50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856777" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cystic Fibrosis Foundation pulmonary guideline. Pharmacologic approaches to prevention and eradication of initial Pseudomonas aeruginosa infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Mogayzel Jr" 1 => "E.T. Naureckas" 2 => "K.A. Robinson" 3 => "C. Brady" 4 => "M. Guill" 5 => "T. Lahiri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.201404-166OC" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2014" "volumen" => "11" "paginaInicial" => "1640" "paginaFinal" => "1650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25549030" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack455357" "titulo" => "Acknowledgements" "texto" => "We wish to thank all the CF departments that took part in the survey on the 2 occasions they were submitted, and the members of the Ayre Conference-Spanish Consensus Working Group for their invaluable collaboration in the preparation of the study." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000006/v1_202003210833/S2387020620300589/v1_202003210833/en/main.assets" "Apartado" => array:4 [ "identificador" => "44145" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000006/v1_202003210833/S2387020620300589/v1_202003210833/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300589?idApp=UINPBA00004N"]