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Changing Prevalence of Lower Airway Infections in Young Children with Cystic Fibrosis

Oded Breuer1,2, Andre Schultz1,3,2, Lidija Turkovic1

  • 1Telethon Kids Respiratory Research Centre, Telethon Kids Institute, and.

American Journal of Respiratory and Critical Care Medicine
|February 28, 2019
PubMed

Insights

In cystic fibrosis (CF) patients, Aspergillus species are now common early airway infections, unlike historical patterns. Aggressive treatment reduced Staphylococcus aureus and Pseudomonas aeruginosa, making Aspergillus the most frequent pathogen in young children.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Cystic Fibrosis Research

Background:

  • Historical data suggest Staphylococcus aureus and Haemophilus influenzae initiate airway infections in cystic fibrosis, with Pseudomonas aeruginosa emerging later.
  • Aspergillus species were considered infrequent, late-occurring infections in cystic fibrosis patients.

Purpose of the Study:

  • To determine the prevalence and changes in early lower airway infections in a contemporary cohort of children with cystic fibrosis.
  • To analyze the longitudinal trends of microbial colonization in infants diagnosed with CF via newborn screening.

Main Methods:

  • Infants diagnosed with cystic fibrosis (CF) after newborn screening in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) cohort (2000-2018) were included.
  • Bronchoalveolar lavage (BAL) was performed prospectively from 3-6 months of age, annually up to 6 years.
  • Generalized estimating equations were used to assess longitudinal changes in infection prevalence, controlling for age and repeat visits.

Main Results:

  • Out of 380 infants and 1,759 BALs, key pathogens identified were: Staphylococcus aureus (11% prevalence, 2.5 years median age), Pseudomonas aeruginosa (8%, 2.4 years), Aspergillus species (11%, 3.2 years), and Haemophilus influenzae (9%, 3.1 years).
  • A significant decrease in Pseudomonas aeruginosa (P < 0.001) and Staphylococcus aureus (P < 0.001) prevalence was observed, coinciding with intensified treatment protocols.
  • Prevalence of Aspergillus infections remained stable (P = 0.669) throughout the study period.

Conclusions:

  • Aspergillus species and Pseudomonas aeruginosa are frequently detected in the lower airways of infants with cystic fibrosis.
  • The decline in Pseudomonas aeruginosa and Staphylococcus aureus since 2000, linked to aggressive therapeutic strategies, has led to Aspergillus becoming the predominant pathogen in young CF patients.
  • Further investigation is needed to elucidate the clinical implications of these shifts in early-onset airway infections in cystic fibrosis.

Keywords:
BAL

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