Both the presence of P. aeruginosa and its phenotype (., developing a mucoid biofilm due to production of alginate as well as high-level resistance to multiple antibiotics) have been shown to correlate with severity of patient illness ( 55 ). This mucoid property predicts chronic infection that cannot be cleared. CF patients with P. aeruginosa have a decreased life expectancy of 30 years, compared with 40 years in non-colonized patients. They also experience a more rapid decline in pulmonary function and more frequent hospitalizations ( 72 ). On the other hand, anti-Pseudomonal therapy that decreases sputum colonization is associated with improved pulmonary function and improvement in clinical scores ( 174 ) [ See chapter on Cystic Fibrosis & P. aeruginosa . ] P. aeruginosa in the paranasal sinuses in cystic fibrosis patients frequently leads to acute and chronic infections, commonly complicated by nasal polyps. P. aeruginosa is otherwise an extremely rare finding in the sinuses in the non-cystic fibrosis population.
Answer E is incorrect for the following reasons. There is no guideline regarding the use of imaging methods to assess therapy response. However, individualized assessment with FDG PET appears promising. Osborne et al. analyzed 23 patients with CS who were treated with immunosuppressive therapies and were followed with serial FDG PET imaging. The authors found that a reduction in the volume or intensity of myocardial inflammation was associated with an increase in ejection fraction. 24 Further studies are needed to better understand the role of serial FDG PET imaging in directing therapy.