TY - JOUR
T1 - Risk factors for persistent Aspergillus respiratory isolation in cystic fibrosis
AU - Hong, Gina
AU - Psoter, Kevin J.
AU - Jennings, Mark T.
AU - Merlo, Christian A.
AU - Boyle, Michael P.
AU - Hadjiliadis, Denis
AU - Kawut, Steven M.
AU - Lechtzin, Noah
N1 - Funding Information:
Supports: This work was supported by the Cystic Fibrosis Foundation [grant HONG14A0 ].
Publisher Copyright:
© 2018 European Cystic Fibrosis Society
PY - 2018/9
Y1 - 2018/9
N2 - Background: Aspergillus species are increasingly detected in the respiratory tracts of individuals with cystic fibrosis (CF), and chronic Aspergillus fumigatus is associated with more frequent hospitalizations for pulmonary exacerbations. However, patient and clinical factors that may contribute to the acquisition of persistent Aspergillus infection have yet to be identified. The objective of this study was to identify risk factors for development of Aspergillus respiratory isolation in CF. Methods: A retrospective cohort study of participants in the CF Foundation Patient Registry between 2006 and 2012 was conducted. Generalized estimating equation models were used to evaluate the association between the development of persistent Aspergillus respiratory isolation and individual level demographic and clinical characteristics. Results: Among 16,095 individuals with CF followed from 2006 to 2012, 1541 (9.6%) subjects developed persistent Aspergillus isolation. White race (Odds Ratio [OR] 1.74, 95% confidence interval 1.23, 2.48, p < 0.001) and pancreatic insufficiency (OR 1.50, 95% CI 1.09, 2.06, p < 0.001) were found to be risk factors for persistent Aspergillus isolation. Chronic therapies, including inhaled antibiotics (OR 1.33; 95% CI 1.21, 1.46), macrolides (OR 1.23, 95% CI 1.14, 1.32, p < 0.001), and inhaled corticosteroids (OR 1.13, 95% CI 1.04, 1.20, p < 0.001) were also independently associated with an increased risk for persistent Aspergillus isolation. Conclusions: We identified macrolides and inhaled antibiotics, which individually have been shown to improve CF outcomes, and inhaled corticosteroids as risk factors for developing persistent Aspergillus isolation. Further work is needed to determine whether these associations are causal or due to confounding by other factors.
AB - Background: Aspergillus species are increasingly detected in the respiratory tracts of individuals with cystic fibrosis (CF), and chronic Aspergillus fumigatus is associated with more frequent hospitalizations for pulmonary exacerbations. However, patient and clinical factors that may contribute to the acquisition of persistent Aspergillus infection have yet to be identified. The objective of this study was to identify risk factors for development of Aspergillus respiratory isolation in CF. Methods: A retrospective cohort study of participants in the CF Foundation Patient Registry between 2006 and 2012 was conducted. Generalized estimating equation models were used to evaluate the association between the development of persistent Aspergillus respiratory isolation and individual level demographic and clinical characteristics. Results: Among 16,095 individuals with CF followed from 2006 to 2012, 1541 (9.6%) subjects developed persistent Aspergillus isolation. White race (Odds Ratio [OR] 1.74, 95% confidence interval 1.23, 2.48, p < 0.001) and pancreatic insufficiency (OR 1.50, 95% CI 1.09, 2.06, p < 0.001) were found to be risk factors for persistent Aspergillus isolation. Chronic therapies, including inhaled antibiotics (OR 1.33; 95% CI 1.21, 1.46), macrolides (OR 1.23, 95% CI 1.14, 1.32, p < 0.001), and inhaled corticosteroids (OR 1.13, 95% CI 1.04, 1.20, p < 0.001) were also independently associated with an increased risk for persistent Aspergillus isolation. Conclusions: We identified macrolides and inhaled antibiotics, which individually have been shown to improve CF outcomes, and inhaled corticosteroids as risk factors for developing persistent Aspergillus isolation. Further work is needed to determine whether these associations are causal or due to confounding by other factors.
KW - Aspergillus
KW - Cystic fibrosis
KW - Epidemiology
KW - Fungus
KW - Inhaled antibiotics
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U2 - 10.1016/j.jcf.2018.01.008
DO - 10.1016/j.jcf.2018.01.008
M3 - Article
C2 - 29444760
AN - SCOPUS:85044661819
SN - 1569-1993
VL - 17
SP - 624
EP - 630
JO - Journal of Cystic Fibrosis
JF - Journal of Cystic Fibrosis
IS - 5
ER -