Clinical Outcomes Associated with Achromobacter Species Infection in Patients with Cystic Fibrosis.

Autor: Somayaji R; 1 Department of Medicine, University of Calgary, Calgary, Alberta, Canada., Stanojevic S; 2 Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada., Tullis DE; 3 Division of Respirology and Keenan Research Centre of Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada; and., Stephenson AL; 3 Division of Respirology and Keenan Research Centre of Li Ka Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada; and., Ratjen F; 2 Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada., Waters V; 4 Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Annals of the American Thoracic Society [Ann Am Thorac Soc] 2017 Sep; Vol. 14 (9), pp. 1412-1418.
DOI: 10.1513/AnnalsATS.201701-071OC
Abstrakt: Rationale: Achromobacter species are increasingly identified in individuals with cystic fibrosis (CF), but the clinical outcomes in these patients remain poorly understood.
Objectives: We aimed to determine the association of Achromobacter infection on clinical outcomes in pediatric and adult patients with CF.
Methods: A cohort study of pediatric and adult patients with CF was conducted from 1997 to 2014 in Toronto, Ontario, Canada. Achromobacter spp. infection was categorized as no history of infection, intermittent infection, and chronic infection (two or more positive cultures in the preceding 12 months). Cox models were used to estimate risk of death or transplantation. Mixed-effects models were used to assess odds of pulmonary exacerbations and effect on lung function (FEV 1 %) by Achromobacter spp.
Results: A total of 1,103 patients were followed-up over the course of 18 years; 88 patients (7.3%) had one or more culture for Achromobacter species. Chronic Achromobacter infection was associated with a greater risk of death or transplantation compared with in patients with no history of infection (adjusted hazard ratio, 2.03; 95% confidence interval, 1.05-3.95; P = 0.036). Pulmonary exacerbations were more common in patients with chronic infection, but after adjusting for confounding factors, the effect was no longer significant. The chronic group had lower FEV 1 %, but it did not worsen after developing chronic infection.
Conclusions: Patients with CF and chronic Achromobacter infection are at increased risk of death or transplantation.
Databáze: MEDLINE
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