Somayaji Ranjani, Yau Yvonne C W, Tullis Elizabeth, LiPuma John J, Ratjen Felix, Waters Valerie
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Pediatric Laboratory Medicine.
Ann Am Thorac Soc. 2020 Dec;17(12):1542-1548. doi: 10.1513/AnnalsATS.202003-204OC.
Little is known in contemporary cystic fibrosis (CF) cohorts about the outcomes after new species infections. To evaluate the changing epidemiology and clinical outcomes associated with species infections in persons with CF. A cohort study of children and adults with CF was conducted from 1997 to 2018 in Toronto, Canada. Patients were characterized as those with no history of species infection and as those who were culture-positive for species for the first time in this time frame and were categorized by species (. , , , or other) and strain ( ET-12). Cox models were used to estimate the risk of death or transplantation. Mixed-effects models were used to assess the impact of species on odds of pulmonary exacerbations and effect on lung function (percentage predicted forced expiratory volume in 1 second [FEV]). A total of 1,196 patients were followed over 20 years; 88 patients (7.4%) had one or more culture-positive for species. Patients with ET-12 infection had a median time to death of 1.95 years compared with 5.30-6.72 years for those with other infections. ET-12 infection was associated with a greater risk of death or transplantation compared with patients with no history of infection in a univariate model (hazard ratio, 3.92; 95% confidence interval 2.25-6.81) but was no longer significant after adjusting for confounders. Pulmonary exacerbations were more common in those with infections and remained significant in the ET-12 group after adjusting for confounders (odds ratio, 2.96; 95% confidence interval, 1.17-7.53). No differences were noted in baseline FEV% or the rate of FEV% decline between the groups with and without species infection. With the exception of ET-12, the acquisition of species infection did not appear to worsen clinical outcomes compared with those with no history of infection. Given this, prognosis, management and clinical trial inclusion protocols may need to be reevaluated for persons with infection.
在当代囊性纤维化（CF）队列中，关于新物种感染后的结局知之甚少。为了评估与CF患者物种感染相关的不断变化的流行病学和临床结局。1997年至2018年在加拿大多伦多对儿童和成人CF患者进行了一项队列研究。患者被分为无物种感染史的患者以及在此时间范围内首次物种培养呈阳性的患者，并按物种（如 、 、 或其他）和菌株（如ET-12）进行分类。使用Cox模型估计死亡或移植风险。使用混合效应模型评估物种对肺部加重几率的影响以及对肺功能（预测的1秒用力呼气量[FEV]百分比）的影响。20年间共随访了1196例患者；88例患者（7.4%）有一次或多次物种培养呈阳性。与其他感染患者的5.30 - 6.72年相比，ET-12感染患者的中位死亡时间为1.95年。在单变量模型中，与无感染史的患者相比，ET-12感染与更高的死亡或移植风险相关（风险比，3.92；95%置信区间2.25 - 6.81），但在调整混杂因素后不再显著。肺部加重在感染患者中更常见，在调整混杂因素后，ET-12组中仍显著（优势比，2.96；95%置信区间，1.17 - 7.53）。有和无物种感染的组之间在基线FEV%或FEV%下降率方面未发现差异。除ET-12外，与无感染史的患者相比，物种感染的发生似乎并未使临床结局恶化。鉴于此，对于感染患者的预后、管理和临床试验纳入方案可能需要重新评估。
