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Factors Associated with Worse Lung Function in Cystic Fibrosis Patients with Persistent Staphylococcus aureus
Sibylle Junge1, Dennis Görlich2, Martijn den Reijer3
1Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover, Hannover, Germany.
Background:
Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads.
Methods:
Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors.
Results:
195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001). Patients with exacerbations (n = 60), S. aureus small-colony variants (SCVs, n = 84) and co-infection with Stenotrophomonas maltophilia (n = 44) had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103). Patients with SCVs were older (p = 0.0066) and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078). IL-6 levels positively correlated with decreased lung function (p<0.001), S. aureus density in sputa (p = 0.0016), SCVs (p = 0.0209), exacerbations (p = 0.0041) and co-infections with S. maltophilia (p = 0.0195) or A. fumigatus (p = 0.0496).
Conclusions:
In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia.
Trial Registration:
ClinicalTrials.gov NCT00669760.
Insights
High Staphylococcus aureus density in throat cultures is linked to faster lung function decline in cystic fibrosis (CF) patients. Other risk factors include exacerbations, elevated IL-6, S. aureus small-colony variants, and Stenotrophomonas maltophilia co-infection.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- Staphylococcus aureus is a significant pathogen in cystic fibrosis (CF) patients.
- Factors influencing lung function decline in CF patients with persistent S. aureus are not fully understood.
- This study investigated the relationship between S. aureus bacterial load and lung function deterioration.
Purpose of the Study:
- To determine if high S. aureus density in respiratory specimens correlates with worsening lung function in CF patients.
- To identify other clinical and microbiological factors associated with lung function decline.
Main Methods:
- An observational, prospective, longitudinal, multi-center study involving 195 CF patients.
- Assessment of lung function, S. aureus bacterial density (throat and sputum), co-infections, nasal carriage, clinical status, antibiotic use, and IL-6/IgG levels.
- Data analyzed using descriptive statistics and generalized linear mixed models.
Main Results:
- High S. aureus density in throat cultures was associated with a steeper lung function decline (p<0.001).
- Exacerbations, S. aureus small-colony variants (SCVs), and Stenotrophomonas maltophilia co-infection were linked to worse lung function.
- Elevated IL-6 levels correlated with decreased lung function, higher S. aureus density, SCVs, exacerbations, and co-infections.
Conclusions:
- Independent risk factors for worse lung function in CF patients with chronic S. aureus include high bacterial density in throat cultures, exacerbations, elevated IL-6, S. aureus SCVs, and S. maltophilia co-infection.
- Bacterial load and specific clinical factors significantly impact disease progression in CF.
- Further research into targeted interventions for these risk factors is warranted.
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