Abstract
BackgroundPulmonary infection is the main cause of death in cystic fibrosis (CF). Aspergillus fumigatus (AF) and Pseudomonas aeruginosa (PA) are the most prevalent fungal and bacterial pathogens isolated from the CF airway, respectively. Our aim was to determine the effect of different colonisation profiles of AF and PA on the clinical status of patients with CF.MethodsA retrospective analysis of data from the Cystic Fibrosis Registry of Ireland from 2013 was performed to determine the effect of intermittent and persistent colonisation with AF or PA or co-colonisation with both microorganisms on clinical outcome measures in patients with CF. Key outcomes measured included forced expiratory volume in one second (FEV1), number of hospitalisations, respiratory exacerbations and antimicrobials prescribed, and complications of CF, including CF related diabetes (CFRD) and allergic bronchopulmonary aspergillosis (ABPA).ResultsThe prevalence of AF and PA colonisation were 11% (5% persistent, 6% intermittent) and 31% (19% persistent, 12% intermittent) in the Irish CF population, respectively. Co-colonisation with both pathogens was associated with a 13.8% reduction in FEV1 (p = 0.016), higher levels of exacerbations (p = 0.042), hospitalisations (p = 0.023) and antimicrobial usage (p = 0.014) compared to non-colonised patients and these clinical outcomes were comparable to those persistently colonised with PA. Intermittent and persistent AF colonisation were not associated with poorer clinical outcomes or ABPA. Patients with persistent PA had a higher prevalence of CFRD diagnosis (p = 0.012).ConclusionsCF patients co-colonised with AF and PA had poor clinical outcomes comparable to patients persistently colonised with PA, emphasising the clinical significance of co-colonisation with these microorganisms.
Highlights
Pulmonary infection is the main cause of death in cystic fibrosis (CF)
Aspergillus fumigatus (AF) colonisation was most prevalent in pre-adolescents and adolescents (Fig. 1), which contradicts current opinion that AF is more commonly an organism encountered in adulthood
Persistent colonisation with Pseudomonas aeruginosa (PA) or co-colonisation with both PA and AF was associated with more frequent hospitalisations, more respiratory exacerbations and higher use of antimicrobials For the first time we have shown that being culture positive for both AF and PA is associated with similar levels of hospital admissions, exacerbations and antimicrobial prescribing as being persistently colonised with PA (Table 2)
Summary
Pulmonary infection is the main cause of death in cystic fibrosis (CF). Aspergillus fumigatus (AF) and Pseudomonas aeruginosa (PA) are the most prevalent fungal and bacterial pathogens isolated from the CF airway, respectively. It is estimated that there are over 70,000 people living with CF worldwide [1]. It is a multi-organ disease up to 95% of morbidity and mortality is caused by airway infections. Reece et al BMC Pulmonary Medicine (2017) 17:70 are colonised with a community of microorganisms from an early age [2,3,4]. We aimed to determine the clinical implications of coinfection with the most common fungal and bacterial pathogen isolated from the CF airways
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