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Respiratory infection rates differ between geographically distant paediatric cystic fibrosis cohorts

Kathryn A Ramsey¹, Emily Hart², Lidija Turkovic³

¹Telethon Kids Institute, University of Western Australia, Perth, Australia; Cystic Fibrosis Research and Treatment Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; These authors contributed equally to this paper.

ERJ Open Research

|December 14, 2016

Insights

Children with cystic fibrosis (CF) in Melbourne acquired respiratory infections earlier and had worse lung disease compared to Perth. Geographical factors may influence early infection and CF outcomes.

Area of Science:

Pediatrics
Pulmonology
Infectious Diseases

Background:

Respiratory infections significantly impact lung health in children with cystic fibrosis (CF).
Geographical variations in infection prevalence can affect CF patient outcomes.

Purpose of the Study:

To compare the prevalence of respiratory infections and lung disease in early life between two geographically distinct cystic fibrosis (CF) treatment centers in Australia.
To identify potential factors contributing to observed differences in infection and disease severity.

Main Methods:

A surveillance program evaluated lower airway microbiology, inflammation, and structural lung disease in 260 children (0-8 years) with CF over 1032 visits.
Data were collected from CF treatment centers in Melbourne and Perth, Australia.

Main Results:

Melbourne patients showed higher rates of respiratory pathogen culture positivity across all age groups (OR 1.85).
Infants (<2 years) in Melbourne had increased neutrophil elastase (OR 3.11).
Bronchiectasis (OR 2.02) and air trapping (OR 2.53) were more common in Melbourne children aged 2-5 years, with worse structural lung disease in older children (>5 years). Hospitalization and antibiotic rates were similar between centers.

Conclusions:

Geographical differences in early respiratory infection acquisition may contribute to variability in cystic fibrosis outcomes between treatment centers.
No procedural differences were identified to explain the observed disparities in pathogen prevalence.

Read full analysis

Abstract:

Respiratory infections are a major cause of pulmonary decline in children with cystic fibrosis (CF). We compared the prevalence of infection in early life at geographically distant CF treatment centres participating in the same surveillance programme in Australia. Lower airway microbiology, inflammation and structural lung disease at annual review were evaluated for 260 children 0-8 years old with CF at 1032 visits to CF treatment centres in Melbourne or Perth. Melbourne patients were more likely to be culture-positive for common respiratory pathogens at all age groups (odds ratio (OR) 1.85, 95% CI 1.33-2.58). Subjects <2 years old in Melbourne were also more likely to have neutrophil elastase present (OR 3.11, 95% CI 1.62-5.95). Bronchiectasis (OR 2.02, 95% CI 1.21-3.38) and air trapping (OR 2.53, 95% CI 1.42-4.51) in subjects 2-5 years old was more common in Melbourne subjects. The severity of structural lung disease was also worse in Melbourne patients >5 years old. Patients at both centres had a similar rate of hospitalisations and prescribed antibiotics. No procedural differences were identified that could explain the disparity between pathogen prevalence. Geographical differences in early acquisition of infection may contribute to variability in outcomes between CF centres.

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