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Risk factors for persistent Aspergillus respiratory isolation in cystic fibrosis

Gina Hong1, Kevin J Psoter2, Mark T Jennings3

  • 1University of Pennsylvania Perelman School of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Philadelphia, PA, United States.

Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society
|February 16, 2018
PubMed
Abstract

Insights

Persistent Aspergillus respiratory infection in cystic fibrosis (CF) patients is linked to white race, pancreatic insufficiency, and certain chronic therapies. These findings highlight potential risk factors for Aspergillus acquisition in CF individuals.

Area of Science:

  • Medical research
  • Pulmonology
  • Infectious diseases

Background:

  • Aspergillus species are increasingly detected in the respiratory tracts of individuals with cystic fibrosis (CF).
  • Chronic Aspergillus fumigatus infection is associated with more frequent hospitalizations for pulmonary exacerbations in CF patients.
  • Patient and clinical factors contributing to persistent Aspergillus infection in CF remain largely unidentified.

Purpose of the Study:

  • To identify risk factors associated with the development of persistent Aspergillus respiratory isolation in individuals with cystic fibrosis.
  • To investigate demographic and clinical characteristics that may predispose CF patients to persistent Aspergillus infection.

Main Methods:

  • A retrospective cohort study was conducted using data from the CF Foundation Patient Registry (2006-2012).
  • Generalized estimating equation models were employed to analyze associations between persistent Aspergillus isolation and patient characteristics.
  • Individual-level demographic and clinical data were evaluated for their impact on Aspergillus acquisition.

Main Results:

  • Among 16,095 CF patients, 9.6% developed persistent Aspergillus isolation.
  • White race (OR 1.74) and pancreatic insufficiency (OR 1.50) were identified as significant risk factors.
  • Chronic therapies including inhaled antibiotics (OR 1.33), macrolides (OR 1.23), and inhaled corticosteroids (OR 1.13) were independently associated with increased risk.

Conclusions:

  • Macrolides, inhaled antibiotics, and inhaled corticosteroids were identified as risk factors for persistent Aspergillus isolation in CF.
  • These therapies, while beneficial for CF outcomes, may also increase the risk of Aspergillus infection.
  • Further research is necessary to confirm causality and explore confounding factors in these associations.
Keywords:
AspergillusCystic fibrosisEpidemiologyFungusInhaled antibiotics

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