Risk factors for persistent Aspergillus respiratory isolation in cystic fibrosis

Gina Hong, Kevin J. Psoter, Mark T. Jennings, Christian A. Merlo, Michael P. Boyle, Denis Hadjiliadis, Steven M. Kawut, Noah Lechtzin

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)624-630
Number of pages7
JournalJournal of Cystic Fibrosis
Volume17
Issue number5
DOIs
StatePublished - Sep 2018

Keywords

  • Aspergillus
  • Cystic fibrosis
  • Epidemiology
  • Fungus
  • Inhaled antibiotics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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