Investigation of Growth of Microorganisms within the Spacers of Children with Cystic Fibrosis

Cystic fibrosis is a monogenic disorder in several systems. Since spacers used by these patients may be used several times a day, many of them do not know how to wash and use them, so these devices are good places for bacteria to grow. Therefore, this study was performed to identify and determine the relationship between the growth of microorganisms inside spacers and the effect of washing on possible microbial infections in patients with cystic fibrosis.

This is an intervention pilot study to determine the effect of the growth of microorganisms in the spacer of patients with cystic fibrosis on the exacerbation of pulmonary involvement. In the present study, 30 people were examined as a pilot sample due to the lack of a similar study. Patients were selected from children with cystic fibrosis referred to Imam Reza clinic. The target group was patients with a positive sputum culture (throat). At first, after the last use of a spacer, the culture was taken from the sputum and the inner surface of the spacer. Patients with a positive culture were instructed to wash their spacers in the second step. Washing was done daily after each use and immersion in sterile vinegar solution for 20 minutes and then rinsing and drying spontaneously in air and sun twice a week. After four weeks, the initial questionnaire was completed again for patients, and the change in clinical status was assessed. The error level of the first type was considered equal to 0.05. SPSS software version 26 was used for analysis.

In this study, 30 participants with a mean age of 7.51 (4.21) with a maximum age of 18 years and a minimum of 1.5 years. 19 (63.3) were boys, and 11 (36.7) were girls. None of the demographic and clinical variables were significant to the growth of microorganisms within the spacers in patients with cystic fibrosis. Sixteen patients (53.3%) had negative spacer culture, and 14 patients (46.6%) had positive spacer culture, of which 7 of them had the same result of sputum and throat culture, and in 7 patients, it was different. A 4-week period of using sterile vinegar (as mentioned) to wash spacer and educate families to observe spacer hygiene was performed again, all of which had negative cultures.

It seems that contamination of the spacers used by patients is a relatively common finding (46.6% of patients). Due to the physical condition of these children and their susceptibility to respiratory infections, they may act as a source of microbial infections. Patients with a positive spacer culture had more hospitalizations than patients with a negative culture, which can confirm the relationship between spacer contamination and pulmonary exacerbation of these patients.