G. Mergni

Birth weight for gestational age centiles for Italian neonates

Objective: To provide centiles for birth weight (BW) according to gestational age (GA) and sex for infants born in Italy. Methods: We used records of the whole neonatal population of Tuscany, a region in Italy, from July 1991 to June 2002 as resulting from the database of the cystic fibrosis neonatal screening program (n = 290 129). We excluded as unlikely for GA those BW that were more than two interquartile ranges above the 75th centile or below the 25th centile for each GA and gender group. Results: We present the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles of BW for GA from the 24th to 43rd week of gestation for male and female Italian neonates, as both tables and smoothed curves. Conclusions: The large size of the examined population allows us to provide up-to-date, reliable BW for GA centiles for Italian newborns, especially for lower GAs.

Long-term health outcomes of neonatal screening for cystic fibrosis

Balfour-Lynn’s review1 underlines the benefits of neonatal screening programmes for cystic fibrosis (CFNSP). However, long-term clinical outcomes still need to be clarified. In particular, only a few published studies have compared the clinical outcomes at age 15 years of screened and non-screened cystic fibrosis (CF) patients.2–4 In Tuscany, Italy (3.5 million inhabitants, CF incidence 1 in 4144)5 a CFNSP has been carried out since 1984 together with a centralised follow-up programme. We wanted to evaluate the clinical benefits of CFNSP in an entire population of CF patients 15 years after diagnosis. To this purpose, we compared the clinical conditions of CF patients born in Tuscany since the introduction of the CFNSP and diagnosed by screening with those of patients followed since diagnosis by our centre and born in the same period but diagnosed …

121 Anti-Pseudomonas aeruginosa antibodies and microbiological outcome in not chronically infected patients

Objectives: The present study explored the possible protective effect of IgY on PA lung infection in vivo. Methods: In vivo model of acute lung infection: Balb/c mice were anaesthetized with isoflurane and PAO1 vaccine strain ± specific (S-IgY) or control (C-IgY) was inoculated intranasally. Mice were sacrificed after 2, 6 and 24h and lungs removed aseptically, weighted and suspended in PBS. A blinded observer engaged a clinical scoring system (0−5) of the mice. Lungs were homogenized, serially diluted and cultured on Conradi-Drigalski medium for estimation of bacterial load. Results: Relative lung weight: Lung weights in the S-IgY treated group were significantly reduced 24h post-infection compared to PBS controls (p< 0.03). No significant difference between C-IgY and PBS groups were observed. Clinical symptom score: The clinical score was significantly lower in the S-IgY group compared to controls after 6h (C-IgY: p< 0.05, PBS: p< 0.05). After 24h the clinical score in the S-IgY was reduced additionally compared to controls (PBS: p< 0.002, C-IgY: p< 0.04). No significant difference between C-IgY and PBS groups were observed. Quantitative bacteriology: The bacterial load of S-IgY treated mice was significantly reduced 2h post-infection compared to PBS group (p< 0.02) and C-IgY (p< 0.03) and further reduced 6h post-infection compared to both control groups (PBS: p< 0.0001, C-IgY: p< 0.03). After 24h the lung bacteriology in S-IgY treated mice was reduced by 2 logs compared to PBS (p< 0.0001) and C-IgY (p< 0.0002) groups. Conclusion: The present results imply that anti-PA IgY antibodies protects against PA lung infection due to readily bacterial clearance in the airways.

156 Chronic airway colonization by Aspergillus fumigatus (Af) in patients with cystic fibrosis (CF): Does it contribute to lung function decline?

Objectives: Nebulised therapy plays a major role in the treatment of CF. Maintaining nebuliser hygiene is time consuming and if inadequate can result in fungal contamination. The aim of this study was to assess the prevalence of fungal contamination in nebuliser devices. Methods: Adult patients were prospectively recruited. Nebulisers were sampled using wet sterile swabs. Samples including controls were plated out on Sabouraud agar and on Scel+ agar to select for Scedosporium sp. and incubated at 27oC for up to 2 weeks. Yeasts were identified by germ tube test, Auxacolour, or MALDI-TOF examination. Moulds were identified by microscopy, or examination of rRNA gene and spacer sequence. A total of 275 devices/i-neb chambers from 149 subjects were swabbed. In addition swabs were taken from the horn of 94 i-neb devices. Fungal cultures were positive in one or more devices from 86 (57.7%) patients. In 39/149 (26.2%) of study subjects yeasts were isolated, in 47/149 (31.5%) moulds and 20/149 (13.4%) yeasts and moulds. Contamination was not associated with any particular medication and there was no significant difference between the contamination rate of and different devices. Aspergillus sp. were isolated from 28 (10.4%) devices, Scedosporium sp. were not isolated from any devices. There was no obvious correlation between positive culture from devices and previous sputum specimens. Conclusion: Nebuliser devices are frequently contaminated by moulds and yeasts, resulting in a potential vehicle for infection. More emphasis should be placed on ensuring adequate nebuliser hygiene and the development of disposable devices. Supported by an educational grant from Novartis.

46 Delay in meconium emission: should it be considered a risk for cystic fibrosis?

Background: Ten to 15% of CF infants present with meconium ileus (MI), that sometimes can lead to intestinal malformation. Serum immunoreactive trypsin (IRT) levels may be normal and newborn screening (NBS) could be erroneously considered negative. In our CFNBS protocol newborn babies presenting problems with meconium passage (delay in meconium emission − MD − included) undergo sweat test also if IRT is negative Aim: The aim of this study is to investigate the incidence of CF in neonates with MI and MD to determine if infants with this last condition have to be submitted to CF diagnostic test. Patients and Method: A retrospective 5-year study examines neonates screened in our Center that presented problems in meconium passage, with regard to IRT values and CF diagnosis. Results: In a 5-year period (2006–2010) we screened 172,185 newborns and diagnosed 50 CF. Eigthy-two newborns were reported having some problems related to meconium passage: 13 were referred as MI (group 1), 7 as intestinal atresia (IA) (group 2), 62 as MD (group 3). In group 1 8/13 had IRT positive, 6/13 were diagnosed as CF and one of them had IRT normal value; 2 died without diagnosis. In group 2 6/7 had IRT negative, 2/7 had CF and one of them was IRT negative. In group 3 nobody out 62 had IRT positive, nor positive sweat test. Conclusion: In this series 12% of CF neonates presented with MI and/or IA, and 2 of them were IRT negative confirming that CF with MI and IA can have negative NBS. Delay in meconium pass is therefore, asscociated neither with positive screening nor with CF, suggesting that newborns with MD and IRT negative don’t require further analysis for CF.

107 Treatment of multiresistant Gram-negative non-fermentative infections in Cystic Fibrosis patients: more attention required to in vitro studies

Due to the high degree of resistance to antimicrobial agents of Gram-negative nonfermenters bacilli isolated from CF patients, there are limited therapeutic options available. The present study evaluates the activity of the most frequently used antibacterial drugs, and the effect of combination of two antibiotic against multiresistant Gramnegative non-fermentative rods. The bactericidal effect was investigated by E-test on 48 multiresistant strains (16 P aeruginosa and 32 B. cepacia-complex) isolated over a period of 3 years from CF patients attending two Italian CF Centers. Meropenem, ceftazidime, tobramycin, were the most active inhibiting 77, 75, and 71% of strains respectively. Seventy-three out of 342 (21%) tested combinations showed a synergistic effect being meropenem + ciprofloxacin (25%) and tobramycin + ceftazidime/ticarcillin (19%) the most active associations against P aeruginosa. Ceftazidime + tobramycin (41%) and meropenem + tobramycin (34%) were the most active against B. cepacia-complex. The higher percentage of antagonistic effect was demonstrated for meropenem + cefepime/tobramycin (19%), ticarcillin + ciprofloxacin (19%) for P aeruginosa strains and cloramphenicol + cotrimoxazole (26%), meropenem + ciprofloxacin (25%), ceftazidime + tobramycin (22%) for B. cepacia-complex members. This study indicates that a choice of effective double antibiotic therapy cannot be made empirically for Gram-negative multiresistant infections. The addition of a second antibiotic was found to be potentially counterproductive, in fact 16% of tested associations resulted in antagonisms with loss of bactericidal effects. 4. Microbiology