Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis

Edith T. Zemanick, Julia Emerson, Valeria Thompson, Sharon McNamara, Wayne J Morgan, Ronald L. Gibson, Margaret Rosenfeld

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives: To evaluate clinical outcomes associated with initial isolation of Pseudomonas aeruginosa (Pa) in a large U.S. cystic fibrosis (CF) cohort in the current era of widespread early Pa eradication therapy.

Methods: Participants were children with CF enrolled in the Early Pseudomonas Infection Control (EPIC) Observational Study who had no isolation of Pa from respiratory cultures prior to enrollment. Population-averaged regression models using generalized estimating equation methods were used to estimate the effect of Pa acquisition on endpoints including lung function, growth, pulmonary exacerbation rate, respiratory signs and symptoms, and respiratory cultures.

Results: Eight hundred thirty-eight subjects were observed for a mean 4.6 (SD 1.2) years during which 431 (51%) acquired Pa. There was no statistically significant effect of Pa acquisition on the slopes of FEV1% predicted or growth parameters. Pulmonary exacerbation rate was statistically significantly greater after Pa acquisition (incident rate ratio 1.40, 95% CI1.07,1.84) 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 S. maltophilia (OR 2.11, 95% CI1.49, 2.98) increased after Pa acquisition, while the odds of H. influenzae (OR 0.54, 95% CI 0.46, 0.64) decreased.

Conclusions: In this large U.S. cohort, we did not detect an association between acquisition of Pa and deterioration in lung function or nutrition. Pa acquisition was associated with significantly increased pulmonary exacerbation rate and odds of crackles or wheeze. Pa infection may be the cause of these outcomes or a marker of more severe disease.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalPediatric Pulmonology
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Pseudomonas
Cystic Fibrosis
Pseudomonas aeruginosa
Lung
Pseudomonas Infections
Respiratory Sounds
Respiratory Signs and Symptoms
Methicillin-Resistant Staphylococcus aureus
Infection Control
Growth
Human Influenza
Observational Studies

Keywords

  • Clinical outcomes
  • Cystic fibrosis
  • Epidemiology
  • Microbiology
  • P. aeruginosa
  • Pulmonary exacerbations

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Zemanick, E. T., Emerson, J., Thompson, V., McNamara, S., Morgan, W. J., Gibson, R. L., & Rosenfeld, M. (2015). Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis. Pediatric Pulmonology, 50(1), 42-48. https://doi.org/10.1002/ppul.23036

Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis. / Zemanick, Edith T.; Emerson, Julia; Thompson, Valeria; McNamara, Sharon; Morgan, Wayne J; Gibson, Ronald L.; Rosenfeld, Margaret.

In: Pediatric Pulmonology, Vol. 50, No. 1, 01.01.2015, p. 42-48.

Research output: Contribution to journalArticle

Zemanick, ET, Emerson, J, Thompson, V, McNamara, S, Morgan, WJ, Gibson, RL & Rosenfeld, M 2015, 'Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis', Pediatric Pulmonology, vol. 50, no. 1, pp. 42-48. https://doi.org/10.1002/ppul.23036
Zemanick, Edith T. ; Emerson, Julia ; Thompson, Valeria ; McNamara, Sharon ; Morgan, Wayne J ; Gibson, Ronald L. ; Rosenfeld, Margaret. / Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis. In: Pediatric Pulmonology. 2015 ; Vol. 50, No. 1. pp. 42-48.
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AB - Objectives: To evaluate clinical outcomes associated with initial isolation of Pseudomonas aeruginosa (Pa) in a large U.S. cystic fibrosis (CF) cohort in the current era of widespread early Pa eradication therapy.Methods: Participants were children with CF enrolled in the Early Pseudomonas Infection Control (EPIC) Observational Study who had no isolation of Pa from respiratory cultures prior to enrollment. Population-averaged regression models using generalized estimating equation methods were used to estimate the effect of Pa acquisition on endpoints including lung function, growth, pulmonary exacerbation rate, respiratory signs and symptoms, and respiratory cultures.Results: Eight hundred thirty-eight subjects were observed for a mean 4.6 (SD 1.2) years during which 431 (51%) acquired Pa. There was no statistically significant effect of Pa acquisition on the slopes of FEV1% predicted or growth parameters. Pulmonary exacerbation rate was statistically significantly greater after Pa acquisition (incident rate ratio 1.40, 95% CI1.07,1.84) 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 S. maltophilia (OR 2.11, 95% CI1.49, 2.98) increased after Pa acquisition, while the odds of H. influenzae (OR 0.54, 95% CI 0.46, 0.64) decreased.Conclusions: In this large U.S. cohort, we did not detect an association between acquisition of Pa and deterioration in lung function or nutrition. Pa acquisition was associated with significantly increased pulmonary exacerbation rate and odds of crackles or wheeze. Pa infection may be the cause of these outcomes or a marker of more severe disease.

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