Which of the following is the most likely explanation for the persistent colonization of this patient by the organism?
A 25-year old man with cystic fibrosis comes to the physician because of a 3-day history of fever, cough, and progressive shortness of breath. His temperature is 38C (100.4F) and respirations are 32/min. Bilateral crackles and rhonchi are heard on auscultation of the chest. A nutrient agar plate seeded with bronchial secretions grows anaerobic, oxidase-positive, gram-negative rod that forms slimy colonies and produces pyocyanin. The organism does not ferment lactose. Treatment with multiple appropriate antibiotics has not LED to the eradication of the causal organism.
A. Bacteriophage superinfection B. Biofilm formation the lower respiratory tract C. Overgrowth of acapsular strains D. Pyocyanin synthesis E. Synthesis of exotoxin A