Edwards B D, Somayaji R, Greysson-Wong J, Izydorczyk C, Waddell B, Storey D G, Rabin H R, Surette M G, Parkins M D
Department of Medicine, University of Calgary.
Department of Microbiology, Immunology and Infectious Diseases, University of Calgary.
Open Forum Infect Dis. 2019 Nov 18;7(1):ofz476. doi: 10.1093/ofid/ofz476. eCollection 2020 Jan.
Analysis of "" pathogens in cystic fibrosis (CF) lung disease has focused on unique pathogens that are rare in other human diseases or are drug resistant. is recovered in the sputum of up to 25% of patients with CF, yet little is known about the epidemiology or clinical impact of infection.
We studied patients attending a Canadian adult CF clinic who had positive sputum cultures for from 1978 to 2016. Infection was categorized as transient or persistent (≥3 positive sputum cultures, spanning >6 months). Those with persistent infection were matched 2:1 with age, sex, and time-period controls without history of infection, and mixed-effects models were used to assess pulmonary exacerbation (PEx) frequency, lung function decline, hospitalization, and intravenous antibiotic days.
Forty-five patients (12.3%) had recovered from sputum samples between 1978 and 2016, and 18 patients (40%) developed persistent infection. Nine patients (24%) had PEx at incident infection, and increased bioburden was predictive of exacerbation ( = .03). Risk factors for persistent infection included lower nutritional status ( < .001) and lower lung function ( = .009), but chronic infection with was protective. There was no difference in annual lung function decline, need for hospitalization or intravenous antibiotics, or risk of PEx in patients with persistent infection.
Persistent infection was frequent and was more common in CF patients with low nutritional status and lung function. However, this does not predict clinical decline. Multicenter studies would allow better characterization of the epidemiology and clinical impact of infection.
对囊性纤维化（CF）肺部疾病中“病原体”的分析主要集中在其他人类疾病中罕见或具有耐药性的独特病原体上。在高达25%的CF患者痰液中可检测到该病原体，但对其感染的流行病学或临床影响知之甚少。
我们研究了1978年至2016年间在加拿大一家成人CF诊所就诊且痰液培养该病原体呈阳性的患者。感染分为短暂性或持续性（≥3次痰液培养阳性，持续时间>6个月）。将持续性感染患者与年龄、性别和时间段匹配但无该病原体感染史的对照者按2:1比例配对，并使用混合效应模型评估肺部加重（PEx）频率、肺功能下降、住院情况和静脉使用抗生素天数。
1978年至2016年间，45例患者（12.3%）痰液样本中检测到该病原体，18例患者（40%）发生持续性感染。9例患者（24%）在初次感染时出现PEx，生物负荷增加可预测病情加重（P = 0.03）。持续性感染的危险因素包括营养状况较差（P < 0.001）和肺功能较低（P = 0.009），但该病原体的慢性感染具有保护作用。持续性感染患者的年肺功能下降、住院或静脉使用抗生素的需求以及PEx风险无差异。
持续性该病原体感染很常见，在营养状况和肺功能较差的CF患者中更常见。然而，这并不能预测临床病情恶化。多中心研究将有助于更好地描述该病原体感染的流行病学和临床影响。
