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Background  Cystic Fibrosis (CF) patients are vulnerable to airway colonization with  Pseudomonas aeruginosa . In case eradication fails after antibiotic treatment, patients become chronically colonized with  P. aeruginosa , with recurrent pulmonary exacerbation, for which patients typically are hospitalized for 2 weeks and receive intravenous antibiotic treatment. Normally, improvement of the patients' health is established.    Aim  Determination of the correspondence between patient improvement and changes of the  P. aeruginosa  and total bacterial load in the sputum.    Methods  Eighteen CF patients with exacerbation were included for a total of 27 hospitalization episodes. At day 1, 8 and 15, inflammation and lung function parameters were determined, together with the  P. aeruginosa  load in the sputum using culture, quantitative PCR (qPCR) and propidium monoazide qPCR.    Results  Patients improved during hospitalization (decrease in levels of C-reactive protein, white blood cell counts and erythrocyte sedimentation rate, increase of FEV 1 ), reaching normal values already after one week. Also the  P. aeruginosa  load and the total bacterial load decreased during the first week of antibiotic treatment (p<0.05), except for patients with a low lung function (FEV 1 ≤39.4%), for whom no significant decrease of  P. aeruginosa  was established. Comparison of culture-based and propidium monoazide qPCR-based quantification of  P. aeruginosa  showed that at the end of the treatment on average 62% of the  P. aeruginosa  cells are not cultivable, indicating that many cells are alive but dormant, or dead but still structurally intact.    Conclusion  Improvement of the clinical status is accompanied with a decrease of the  P. aeruginosa  load, whereby both occur mainly during the first week of antibiotic treatment. However, for patients with a low lung function, no decrease of the  P. aeruginosa  load is observed. Comparison of detection techniques shows that a large amount of noncultivable or dead bacteria are present in the samples.

Is the Improvement of CF Patients, Hospitalized for Pulmonary Exacerbation, Correlated to a Decrease in Bacterial Load?