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a Department of
Cystic Fibrosis, Royal Brompton Hospital, London SW3 6NP, UK, b Laboratory
of Hospital Infection, Central Public Health Laboratory, London
NW9 5HT, UK
Correspondence to: Dr T L Pitt email: tpitt{at}phls.nhs.uk
Received 3 November 1999; Returned to authors 20 January 2000; Revised version received 4 April 2000; Accepted for publication 15 May 2000
BACKGROUND
Pseudomonas
aeruginosa may undergo a phenotypic change from the wild
(prototrophic) type to an auxotrophic phenotype in the course of
respiratory infection in patients with cystic fibrosis. The clinical
significance of this is unclear. A study was undertaken to investigate
whether the presence of auxotrophs of P
aeruginosa in the sputum of patients with cystic fibrosis
correlated with severity of respiratory disease, and whether increased
sputum concentrations of amino acids were associated with the emergence of these forms.
METHODSSixty adult
patients with cystic fibrosis, colonised by P
aeruginosa, were recruited and baseline clinical data including lung function were recorded. Serial sputum samples were obtained before, during, and after infective exacerbations where possible. These
samples were used for routine microbiological culture, assessment of
auxotrophy of P aeruginosa, measurement of
amino acid content, and neutrophil elastase assay.
RESULTSAuxotrophy was
common in patients with cystic fibrosis and 20 (33%) had a mean
percentage auxotroph count of more than 50% total cfu/ml. The mean
percentage auxotroph count was inversely correlated with forced
expiratory volume in one second (FEV1; 
= -0.194, p = 0.031). The median sputum amino acid concentration of the group was
12.5 mmol/l (range 0.13-40.6). The mean amino acid concentration in
33 subjects during infective exacerbations was 18.2 mmol/l (95% CI
15.1 to 21.3) compared with 12.3 mmol/l (95% CI 9.8 to 14.8) when
well (p = 0.001). The amino acid content of sputum was inversely
correlated with FEV1 ( = -0.253, p = 0.005).
CONCLUSIONSP
aeruginosa frequently exhibits auxotrophy in patients with
cystic fibrosis, particularly in those with severe underlying pulmonary
disease. The sputum amino acid content of patients with cystic fibrosis
is high during infective exacerbations and correlates with pulmonary
disease severity.
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