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Predictors of mucoid Pseudomonas colonization in cystic fibrosis patients
Author(s) -
Levy Hara,
Kalish Leslie A.,
Can Carolyn L.,
García K. Christopher,
Gerard Craig,
Goldmann Don,
Pier Gerald B.,
Weiss Scott T.,
Colin A.A.
Publication year - 2008
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20794
Subject(s) - cystic fibrosis , medicine , pseudomonas aeruginosa , sputum , sputum culture , hazard ratio , staphylococcus aureus , proportional hazards model , immunology , gastroenterology , pathology , bacteria , confidence interval , biology , tuberculosis , genetics
Rationale Chronic mucoid Pseudomonas aeruginosa within the airway in cystic fibrosis (CF) patients can determine prognosis. Understanding the risk factors of mucoid P. aeruginosa acquisition may change how we deliver care. This study aims to evaluate whether presence of risk factors reported to predict disease severity including gender, CFTR genotype, bacterial organisms in airway cultures, and serum levels of vitamins A and E, albumin, C‐reactive protein, alpha 1‐antitrypsin, and immunoglobulins increased the risk of mucoid P. aeruginosa acquisition. Methods Primary endpoint was age at first transition from negative to positive culture for mucoid P. aeruginosa . Cox proportional hazards regression with time‐dependent covariates examined development of mucoid P. aeruginosa infection and its association with longitudinally measured serum biomarkers, pulmonary function, and culture results for other organisms. Results Median ages at CF diagnosis and at first culture were 0.55 and 5.7 years, respectively. Median number of cultures/patient was 17. Of the 323 subjects, 150 developed mucoid P. aeruginosa during a median 8.1 years' follow‐up. In multivariate analysis, gender (relative hazard [RH] 0.55 for male vs. female, P = 0.001), number of DF508 alleles (RH 1.66 for 1 or 2 vs. 0, P = 0.04), FEV 1 % (RH 1.16 for 10% decrease, P = 0.008), and most recent Staphylococcus aureus status (RH 0.24 for positive vs. negative, P < 0.0001) remained statistically significant. Conclusion Female gender, number of DF508 alleles, decreased lung function, and lack of S. aureus on recent sputum culture are important risk factors for early detection of mucoid P. aeruginosa . Pediatr Pulmonol. 2008; 43:463–471. © 2008 Wiley‐Liss, Inc.