Risk Factors for Persistent Aspergillus Respiratory Isolation in Cystic Fibrosis

Overview

Journal J Cyst Fibros

Publisher Elsevier

Specialty Pulmonary Medicine

Date 2018 Feb 16

PMID 29444760

Citations 23

Authors

Gina Hong

Kevin J Psoter

Mark T Jennings

Christian A Merlo

Michael P Boyle

Denis Hadjiliadis

Steven M Kawut

Noah Lechtzin

Affiliations

Soon will be listed here.

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.

Citing Articles

Influence of Fungal Colonization on Exacerbations in Patients with Cystic Fibrosis.

Madrid-Carbajal C, de la Rasilla T, Iscar-Urrutia M, Solis-Garcia M, Fernandez-Alvarez R, Perez-Martinez L J Fungi (Basel). 2024; 10(12).

PMID: 39728371 PMC: 11676277. DOI: 10.3390/jof10120875.

The Real-World Effectiveness of Antifungals in People with Cystic Fibrosis and -Positive Cultures.

Faerber J, Kawut S, Hadjiliadis D, Hong G Ann Am Thorac Soc. 2024; 22(2):193-199.

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Distinct community structures of the fungal microbiome and respiratory health in adults with cystic fibrosis.

Hong G, Daniel S, Lee J, Bittinger K, Glaser L, Mattei L J Cyst Fibros. 2023; 22(4):636-643.

PMID: 36822979 PMC: 10440372. DOI: 10.1016/j.jcf.2023.02.003.

Race and ethnicity: Risk factors for fungal infections?.

Jenks J, Aneke C, Al-Obaidi M, Egger M, Garcia L, Gaines T PLoS Pathog. 2023; 19(1):e1011025.

PMID: 36602962 DOI: 10.1371/journal.ppat.1011025.

Persistent Aspergillus fumigatus infection in cystic fibrosis: impact on lung function and role of treatment of asymptomatic colonization-a registry-based case-control study.

Blomquist A, Inghammar M, Al Shakirchi M, Ericson P, Krantz C, Svedberg M BMC Pulm Med. 2022; 22(1):263.

PMID: 35790954 PMC: 9258124. DOI: 10.1186/s12890-022-02054-3.

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