Abstract
BackgroundThe aim of this study was to assess whether serology and spirometry and the combination of both can complement culture-based detection for earlier recognition of Pseudomonas aeruginosa infection in children with cystic fibrosis.MethodsA 4 year longitudinal prospective study that included 67 Slovenian children with cystic fibrosis with a mean age of 10.5 years was conducted. Serology, spirometry and a scoring system combining serology and spirometry were assessed and compared. Infection was confirmed with isolation of Pseudomonas aeruginosa from respiratory samples.ResultsThere was a significantly positive correlation between serology and the combination of serology and spirometry and Pseudomonas aeruginosa isolation (P < 0.01 for both) and a significantly negative correlation between spirometry and Pseudomonas aeruginosa isolation (P < 0.05). An increase in serology for 1 ELISA unit increased the possibility of Pseudomonas aeruginosa isolation 1.6 times. A fall in FEV1% predicted for 10% increased the possibility of Pseudomonas aeruginosa isolation 9.8 times. Binary logistic regression analysis was used to determine the odds ratios and 95% confidence intervals for all three approaches. Serology had the highest specificity (0.80) and the combination of serology and spirometry the highest sensitivity (0.90). Both had a high negative predictive value (0.93 and 0.79 respectively).ConclusionUsing serology and the combination of serology and lung function measurement can be beneficial for earlier detection of infection with Pseudomonas aeruginosa in children with cystic fibrosis when done simultaneously with standard culture-based detection from respiratory samples.
Highlights
The aim of this study was to assess whether serology and spirometry and the combination of both can complement culture-based detection for earlier recognition of Pseudomonas aeruginosa infection in children with cystic fibrosis
The data from the visits was considered complete if it included all the clinical parameters, the result of isolation of P. aeruginosa from the respiratory sample and the serology result and in patients old enough to perform spirometry, the value of FEV1% predicted
To evaluate the accuracy of the used diagnostic approaches to predict P. aeruginosa infection, ROC curves were constructed for serology, spirometry and the combination of serology and spirometry (Fig. 2a, b and c)
Summary
The aim of this study was to assess whether serology and spirometry and the combination of both can complement culture-based detection for earlier recognition of Pseudomonas aeruginosa infection in children with cystic fibrosis. In some patients antibody values can be above the cut-off value for a positive test even when P. aeruginosa is not isolated in respiratory samples If such patients have signs of an exacerbation or a progressive worsening of their clinical status and lung function parameters, further clinical investigations are due as it is possible that P. aeruginosa is not isolated because of technical difficulties even though it is present in the lower airways. On such occasions new methods that would be non-invasive and could increase the possibility of earlier detection of infection in children and non-sputum-producing CF patients would be beneficial
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