García Clemente Marta, Olveira Casilda, Girón Rosa, Máiz Luis, Sibila Oriol, Golpe Rafael, Menéndez Rosario, Rodríguez Juan, Barreiro Esther, Rodríguez Hermosa Juan Luis, Prados Concepción, De la Rosa David, Carbajal Claudia Madrid, Solís Marta, Martínez-García Miguel Ángel
Respiratory Department, Central University Hospital, 33011 Oviedo, Spain.
Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain.
J Clin Med. 2022 Jul 7;11(14):3960. doi: 10.3390/jcm11143960.
The objective of the study was to analyze the factors associated with chronic bronchial infection (CBI) due to methicillin-susceptible Staphylococcus aureus (SA) and assess the clinical impact on severity, exacerbations, hospitalizations, and loss of lung function compared to patients with no isolation of PPMs in a large longitudinal series of patients from the Spanish bronchiectasis registry (RIBRON). Material and methods: A prospective, longitudinal, multicenter study was conducted with patients included in the RIBRON registry between January 2015 and October 2020. The inclusion criteria were an age of 18 years or older and an initial diagnosis of bronchiectasis. Patients recorded in the registry had a situation of clinical stability in the absence of an exacerbation in the four weeks before their inclusion. All patients were encouraged to provide a sputum sample at each visit for microbiological culture. Annual pulmonary function tests were performed according to the national spirometry guidelines. Results: A total of 426 patients were ultimately included in the study: 77 patients (18%) with CBI due to SA and 349 (82%) who did not present any isolation of PPMs in sputum. The mean age was 66.9 years (16.2), and patients 297 (69.7%) were female, with an average BMI of 25.1 (4.7) kg/m2 and an average Charlson index of 1.74 (1.33). The mean baseline value of FEV1 2 L was 0.76, with a mean FEV1% of 78.8% (23.1). One hundred and seventy-two patients (40.4%) had airflow obstruction with FEV1/FVC < 0.7. The mean predictive FACED score was 1.62 (1.41), with a mean value of 2.62 (2.07) for the EFACED score and 7.3 (4.5) for the BSI score. Patients with CBI caused by SA were younger (p < 0.0001), and they had a lower BMI (p = 0.024) and more exacerbations in the previous year (p = 0.019), as well as in the first, second, and third years of follow-up (p = 0.020, p = 0.001, and p = 0.018, respectively). As regards lung function, patients with CBI due to SA had lower levels of FEV1% at the time of inclusion in the registry (p = 0.021), and they presented more frequently with bronchial obstruction (p = 0.042). A lower age (OR: 0.97; 95% CI: 0.94−0.99; p < 0.001), lower FEV1 value% (OR: 0.98; 95% CI: 0.97−0.99; p = 0.035), higher number of affected lobes (OR: 1.53; 95% CI: 1.2−1.95; p < 0.001), and the presence of two or more exacerbations in the previous year (OR: 2.33; 95% CI: 1.15−4.69; p = 0.018) were observed as independent factors associated with CBI due to SA. The reduction in FEv1% in all patients included in the study was −0.31%/year (95% CI: −0.7; −0.07) (p = 0.110). When the reduction in FEv1% is analyzed in the group of patients with CBI due to SA and the group without pathogens, we observed that the reduction in FEV1% was −1.19% (95% CI: −2.09, −0.69) (p < 0.001) in the first group and −0.02% (95% CI: −0.07, −0.01) (p = 0.918) in the second group. According to a linear regression model (mixed effects) applied to determine which factors were associated with a more pronounced reduction in FEv1% in the overall group (including those with CBI due to SA and those with no PPM isolation), age (p = 0.0019), use of inhaled corticosteroids (p = 0.004), presence of CBI due to SA (p = 0.007), female gender (p < 0.001), and the initial value of FEV1 (p < 0.001) were significantly related. Conclusions: Patients with non-CF bronchiectasis with CBI due to SA were younger, with lower FEV1% values, more significant extension of bronchiectasis, and a higher number of exacerbations of mild to moderate symptoms than those with no PPM isolation in respiratory secretions. The reduction in FEV1% was −1.19% (95% CI: −2.09, −0.69) (p < 0.001) in patients with CBI caused by SA.
本研究的目的是分析与甲氧西林敏感金黄色葡萄球菌(SA)所致慢性支气管感染(CBI)相关的因素,并在西班牙支气管扩张症登记处(RIBRON)的大型纵向系列患者中,评估与未分离出潜在病原体的患者相比,SA所致CBI对严重程度、病情加重、住院治疗及肺功能丧失的临床影响。材料与方法:对2015年1月至2020年10月期间纳入RIBRON登记处的患者进行了一项前瞻性、纵向、多中心研究。纳入标准为年龄18岁及以上且初始诊断为支气管扩张症。登记在册的患者在纳入前四周内病情稳定,无病情加重情况。鼓励所有患者每次就诊时提供痰标本进行微生物培养。根据国家肺活量测定指南进行年度肺功能测试。结果:本研究最终纳入426例患者:77例(18%)因SA导致CBI,349例(82%)痰中未分离出任何潜在病原体。平均年龄为66.9岁(16.2),297例(69.7%)患者为女性,平均体重指数为25.1(4.7)kg/m²,平均查尔森指数为1.74(1.33)。FEV₁₂L的平均基线值为0.76,FEV₁%的平均值为78.8%(23.1)。172例(40.4%)患者存在气流受限,FEV₁/FVC < 0.7。预测FACED评分的平均值为1.62(1.41),EFACED评分为2.62(2.07),BSI评分为7.3(4.5)。SA所致CBI患者更年轻(p < 0.0001),体重指数更低(p = 0.024),前一年病情加重次数更多(p = 0.019),在随访的第一、第二和第三年病情加重次数也更多(分别为p = 0.020、p = 0.001和p = 0.018)。在肺功能方面,SA所致CBI患者在纳入登记处时FEV₁%水平较低(p = 0.021),支气管阻塞更为常见(p = 0.042)。年龄较小(OR:0.97;95%CI:0.94 - 0.99;p < 0.001)、FEV₁值%较低(OR:0.98;95%CI:0.97 - 0.99;p = 0.035)、受累肺叶数量较多(OR:1.53;95%CI:1.2 - 1.95;p < 0.001)以及前一年有两次或更多次病情加重(OR:2.33;95%CI:1.15 - 4.69;p = 0.018)被视为与SA所致CBI相关的独立因素。本研究纳入的所有患者中,FEv₁%的下降幅度为每年−0.31%(95%CI:−0.7;−0.07)(p = 0.110)。当分析SA所致CBI患者组和无病原体组的FEv₁%下降情况时,我们观察到第一组FEv₁%的下降幅度为−1.19%((95%CI:−2.09, −0.69)(p < 0.001),第二组为−0.02%(95%CI:−0.07, −0.01)(p = 0.918)。根据应用于确定哪些因素与总体组(包括SA所致CBI患者和未分离出潜在病原体的患者)中FEv₁%更显著下降相关的线性回归模型(混合效应),年龄(p = 0.0019)、吸入性糖皮质激素的使用(p = 0.004)、SA所致CBI的存在(p = 0.007)、女性性别(p < 0.001)和FEv₁的初始值(p < 0.001)显著相关。结论:与呼吸道分泌物中未分离出潜在病原体的患者相比,非囊性纤维化支气管扩张症合并SA所致CBI的患者更年轻,FEV₁%值更低,支气管扩张范围更明显,轻至中度症状加重次数更多。SA所致CBI患者中FEv₁%的下降幅度为−1.19%(95%CI:−2.09, −0.69)(p < 0.001)。