Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis. Issue 1 (18th March 2014)

• Record Type: Journal Article
• Authors: Zemanick, Edith T.; Emerson, Julia; Thompson, Valeria; McNamara, Sharon; Morgan, Wayne; Gibson, Ronald L.; Rosenfeld, Margaret; the EPIC Study Group
• Is Part Of: Pediatric pulmonology. Volume 50:Issue 1(2015:Jan.)
• Page Start: 42
• Page End: 48
• Publication Date: 2014-03-18
• Subjects: Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.23036
• Languages: English
• ISSNs: 8755-6863

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Summary</title> <sec id="ppul23036-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate clinical outcomes associated with initial isolation of <italic>Pseudomonas aeruginosa</italic> (<italic>Pa</italic>) in a large U.S. cystic fibrosis (CF) cohort in the current era of widespread early <italic>Pa</italic> eradication therapy.</p> </sec> <sec id="ppul23036-sec-0002" sec-type="section"> <title>Methods</title> <p>Participants were children with CF enrolled in the Early Pseudomonas Infection Control (EPIC) Observational Study who had no isolation of <italic>Pa</italic> from respiratory cultures prior to enrollment. Population‐averaged regression models using generalized estimating equation methods were used to estimate the effect of <italic>Pa</italic> acquisition on endpoints including lung function, growth, pulmonary exacerbation rate, respiratory signs and symptoms, and respiratory cultures.</p> </sec> <sec id="ppul23036-sec-0003" sec-type="section"> <title>Results</title> <p>Eight hundred thirty‐eight subjects were observed for a mean 4.6 (SD 1.2) years during which 431 (51%) acquired <italic>Pa</italic>. There was no statistically significant effect of <italic>Pa</italic> acquisition on the slopes of FEV<sub>1</sub>% predicted or growth parameters. Pulmonary exacerbation rate was statistically significantly greater after <italic>Pa</italic> acquisition (incident rate ratio 1.40, 95% CI 1.07, 1.84) as were odds of crackles or wheeze on physical exam (OR 1.23, 95% CI 1.00, 1.52). Odds of isolation of MRSA (OR 1.86, 95% CI 1.38, 2.49) and <italic>S. maltophilia</italic> (OR 2.11, 95% CI 1.49, 2.98) increased after <italic>Pa</italic> acquisition, while the odds of <italic>H. influenzae</italic> (OR 0.54, 95% CI 0.46, 0.64) decreased.</p> </sec> <sec id="ppul23036-sec-0004" sec-type="section"> <title>Conclusions</title> <p>In this large U.S. cohort, we did not detect an association between acquisition of <italic>Pa</italic> and deterioration in lung function or nutrition. <italic>Pa</italic> acquisition was associated with significantly increased pulmonary exacerbation rate and odds of crackles or wheeze. <italic>Pa</italic> infection may be the cause of these outcomes or a marker of more severe disease. <bold>Pediatr Pulmonol. 2015; 50:42–48.</bold> © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>