BACKGROUND Early detection of pulmonary contamination in children with cystic fibrosis (CF) is essential since these children are vulnerable to Pseudomonas aeruginosa (P. aeruginosa) colonization. In Iran, home nebulization of antibiotics is a widespread practice in treatment for patients with CF and, to the best our knowledge, no bacteriological surveys have been conducted till date in this regard. METHOD This observational, cross sectional study was conducted on 61 children with CF at Mofid Children's Hospital, Tehran, from September 2017 to march 2018. The swab sampling was performed from 61 home nebulizers used by children diagnosed with CF. Contemporaneous sputum sample or deep nasopharyngeal swab was taken from each patient for bacterial and fungal testing. Medical records of the patients were reviewed and the number of exacerbations were recorded over the last 12 months prior to the study enrollment. RESULTS The results of study showed that, 43 (70.5%) nebulizers were contaminated; 31 (50.8%) mouthpieces, 21 (34.4%) reservoirs, and 11 (18%) connecting tubes. The most common organism to be isolated was P. aeruginosa and was recovered from 19 (31%) nebulizers, 16 of them belonged to patients chronically colonized with P. aeruginosa. The remaining three had at least one positive sputum culture for P. aeruginosa in the past 1 year before the study. There was a significant increase in the number of CF exacerbations with an average number of exacerbation being 1.5 ± 1(SD) over last 12 months in children who had pathogenic organisms recovered from their home nebulizers compared with 0.4 ± 0.7(SD) exacerbations per year in whom non-pathogenic organisms were isolated from their nebulizers (P < 0.001). CONCLUSION The majority of domiciliary nebulizers used by children with CF were contaminated with microorganisms indicating that the nebulizers may serve as potential reservoirs of pathogens for the patients' lung. Perpetuating colonization is a possible concern in the ones recently colonized with P. aeruginosa and, therefore, decontamination of nebulizer requires more attention to prevent ongoing infection. The negative impact of contamination of nebulizer on CF exacerbation requires serious attention and further investigations.

中文翻译：

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囊性纤维化患儿家庭雾化器的微生物污染及其对肺病加重的临床意义。

背景技术在患有囊性纤维化（CF）的儿童中，早期发现肺部污染至关重要，因为这些儿童容易受到铜绿假单胞菌（P. aeruginosa）定植。在伊朗，抗生素的家庭雾化术是治疗CF患者的一种普遍做法，据我们所知，迄今为止，尚未进行任何细菌学调查。方法该观察性横断面研究于2017年9月至2018年3月在德黑兰莫菲德儿童医院对61例CF患儿进行了研究。拭子取样是从61例诊断为CF的患儿使用的家用雾化器中进行的。从每位患者中获取同期痰液样本或鼻咽深部拭子，以进行细菌和真菌检测。回顾了患者的病历，并记录了入组前最后12个月的病情加重次数。结果研究结果表明，有43（70.5％）雾化器被污染；31个（50.8％）吸嘴，21个（34.4％）的气嘴和11个（18％）的连接管。分离出的最常见的生物是铜绿假单胞菌，从19例（31％）雾化器中回收，其中16例属于慢性铜绿假单胞菌定植的患者。在研究前的过去1年中，其余3名患者至少有一种铜绿假单胞菌阳性痰培养物。在过去12个月中，从家用雾化器中恢复出病原性微生物的儿童中，CF恶化的次数显着增加，平均恶化次数为1.5±1（SD），而0.4±0。每年从其雾化器中分离出非致病性生物的病情恶化（P <0.001）。结论CF儿童使用的大多数家用雾化器均被微生物污染，这表明雾化器可能是患者肺部病原体的潜在储存库。在最近被铜绿假单胞菌定殖的菌落中，永久定居是一个可能的问题，因此，雾化器的净化需要更多的注意以防止持续的感染。雾化器污染对CF恶化的负面影响需要引起高度重视和进一步研究。结论CF儿童使用的大多数家用雾化器均被微生物污染，这表明雾化器可能是患者肺部病原体的潜在储存库。在最近被铜绿假单胞菌定殖的菌落中，永久定居是一个可能的问题，因此，雾化器的净化需要更多的注意以防止持续的感染。雾化器污染对CF恶化的负面影响需要引起高度重视和进一步研究。结论CF儿童使用的大多数家用雾化器均被微生物污染，这表明雾化器可能是患者肺部病原体的潜在储存库。在最近被铜绿假单胞菌定殖的人群中，永久定居是一个可能的问题，因此，雾化器的净化需要更多的注意以防止持续的感染。雾化器污染对CF恶化的负面影响需要引起高度重视和进一步研究。