Ramsey Kathryn A, Hart Emily, Turkovic Lidija, Padros-Goossens Marc, Stick Stephen M, Ranganathan Sarath C
Telethon Kids Institute, University of Western Australia, Perth, Australia; Cystic Fibrosis Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; These authors contributed equally to this paper.
Murdoch Children's Research Institute, Parkville, Australia; Dept of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia; These authors contributed equally to this paper.
ERJ Open Res. 2016 Sep 26;2(3). doi: 10.1183/23120541.00014-2016. eCollection 2016 Jul.
Respiratory infections are a major cause of pulmonary decline in children with cystic fibrosis (CF). We compared the prevalence of infection in early life at geographically distant CF treatment centres participating in the same surveillance programme in Australia. Lower airway microbiology, inflammation and structural lung disease at annual review were evaluated for 260 children 0-8 years old with CF at 1032 visits to CF treatment centres in Melbourne or Perth. Melbourne patients were more likely to be culture-positive for common respiratory pathogens at all age groups (odds ratio (OR) 1.85, 95% CI 1.33-2.58). Subjects <2 years old in Melbourne were also more likely to have neutrophil elastase present (OR 3.11, 95% CI 1.62-5.95). Bronchiectasis (OR 2.02, 95% CI 1.21-3.38) and air trapping (OR 2.53, 95% CI 1.42-4.51) in subjects 2-5 years old was more common in Melbourne subjects. The severity of structural lung disease was also worse in Melbourne patients >5 years old. Patients at both centres had a similar rate of hospitalisations and prescribed antibiotics. No procedural differences were identified that could explain the disparity between pathogen prevalence. Geographical differences in early acquisition of infection may contribute to variability in outcomes between CF centres.
呼吸道感染是囊性纤维化（CF）患儿肺部功能衰退的主要原因。我们比较了澳大利亚参与同一监测项目的、地理位置相距较远的CF治疗中心儿童早期感染的患病率。对墨尔本或珀斯CF治疗中心的260名0至8岁CF患儿进行了1032次年度复诊，评估其下呼吸道微生物学、炎症和结构性肺病情况。墨尔本的患者在所有年龄组中，常见呼吸道病原体培养呈阳性的可能性更高（优势比（OR）1.85，95%置信区间1.33 - 2.58）。墨尔本2岁以下的受试者中性粒细胞弹性蛋白酶出现的可能性也更高（OR 3.11，95%置信区间1.62 - 5.95）。2至5岁受试者的支气管扩张（OR 2.02，95%置信区间1.21 - 3.38）和气体潴留（OR 2.53，95%置信区间1.42 - 4.51）在墨尔本受试者中更为常见。5岁以上墨尔本患者的结构性肺病严重程度也更差。两个中心的患者住院率和抗生素处方率相似。未发现可解释病原体患病率差异的操作差异。早期感染获得的地理差异可能导致CF中心之间结局的差异。
