Microbiology review series: CF microbiology - Towards 2020 and beyond

This issue of the Journal of Cystic Fibrosis features the first in a series of three reviews focusing on CF microbiology. The article by Michael Parkins and Andres Floto examines changes in our perception of which bacterial species represent clinically important pathogens in the context of CF lung disease. These shifts have resulted from both technological advances that have improved detection and identification of potential pathogens, and from improvements in therapy that have changed disease course in CF patients. The authors highlight the increasing prevalence of MRSA (particularly in the USA) and the poor clinical outcomes associated with chronic infection; they describe the growing threat represented by nontuberculous mycobacteria, the prevalence of which is increasing beyond what can be explained by improved detection; the potential contribution to pathogenesis of Achromobacter species, a particular concern given frequent multidrug resistance; as well as the contribution of Stenotrophomonas maltophilia to CF lung disease. In each case, they provide a commentary on what an appropriate antibiotic strategy might be. The authors also discuss the need to re-examine the pathogenic potential of many species that have traditionally been selected against by diagnostic microbiological practices, but whose prevalence has been revealed by culture-independent techniques such as 16S rRNA gene sequencing. Finally, they consider the implications of how we define CF pathogens for clinical study design, particularly in the context of antimicrobial therapy.