摘要本指南为临床微生物学实验室提供了处理囊性纤维化(pwCF)患者呼吸道样本的建议。呼吸道样本的适当处理对于检测细菌和真菌病原体至关重要,指导治疗,监测囊性纤维化(CF)病原体的流行病学,并评估治疗干预措施。由于CF跨膜电导调节调节疗法,pwCF的健康状况有所改善,但结果是,更少的pwCF自发咳痰。因此,痰样本的收集有所减少,而其他类型的呼吸道样本,如口咽部和支气管肺泡灌洗样本的收集有所增加。为了优化微生物的检测,包括铜绿假单胞菌,金黄色葡萄球菌,流感嗜血杆菌,和洋葱伯克霍尔德菌;其他不太常见的非乳糖发酵革兰氏阴性杆菌,例如,麦芽窄食单胞菌,Inquilinus,无色杆菌属,Ralstonia,和潘多拉物种;酵母和丝状真菌,非选择性和选择性培养基推荐用于所有类型的呼吸道样品,包括肺移植后从pwCF获得的样品。没有关于实验室实践检测的共识建议,表征,并报告金黄色葡萄球菌的小菌落变体(SCV),尽管研究正在进行中,以解决SCV的潜在临床影响。准确鉴定不太常见的革兰氏阴性杆菌,例如,S、麦芽酚,Inquilinus,无色杆菌属,Ralstonia,和潘多拉物种,以及酵母和丝状真菌,建议了解他们的流行病学和临床进口。
SUMMARYThis guidance presents recommendations for clinical microbiology laboratories for processing respiratory samples from people with cystic fibrosis (pwCF). Appropriate processing of respiratory samples is crucial to detect bacterial and fungal pathogens, guide treatment, monitor the epidemiology of cystic fibrosis (CF) pathogens, and assess therapeutic interventions. Thanks to CF transmembrane conductance regulator modulator therapy, the health of pwCF has improved, but as a result, fewer pwCF spontaneously expectorate sputum. Thus, the collection of sputum samples has decreased, while the collection of other types of respiratory samples such as oropharyngeal and bronchoalveolar lavage samples has increased. To optimize the detection of microorganisms, including Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, and Burkholderia cepacia complex; other less common non-lactose fermenting Gram-negative bacilli, e.g., Stenotrophomonas maltophilia, Inquilinus, Achromobacter, Ralstonia, and Pandoraea species; and yeasts and filamentous fungi, non-selective and selective culture media are recommended for all types of respiratory samples, including samples obtained from pwCF after lung transplantation. There are no consensus recommendations for laboratory practices to detect, characterize, and report small colony variants (SCVs) of S. aureus, although studies are ongoing to address the potential clinical impact of SCVs. Accurate identification of less common Gram-negative bacilli, e.g., S. maltophilia, Inquilinus, Achromobacter, Ralstonia, and Pandoraea species, as well as yeasts and filamentous fungi, is recommended to understand their epidemiology and clinical importance in pwCF. However, conventional biochemical tests and automated platforms may not accurately identify CF pathogens. MALDI-TOF MS provides excellent genus-level identification, but databases may lack representation of CF pathogens to the species-level. Thus, DNA sequence analysis should be routinely available to laboratories for selected clinical circumstances. Antimicrobial susceptibility testing (AST) is not recommended for every routine surveillance culture obtained from pwCF, although selective AST may be helpful, e.g., for unusual pathogens or exacerbations unresponsive to initial therapy. While this guidance reflects current care paradigms for pwCF, recommendations will continue to evolve as CF research expands the evidence base for laboratory practices.