Pseudomonas aeruginosa infection is associated with poorer outcomes in non-cystic fibrosis bronchiectasis. It is unknown whether early eradication improves outcomes. This retrospective study assessed clinical and microbiological outcomes of eradication therapy following initial Pseudomonas infection. All patients undergoing Pseudomonas eradication therapy from 2004 to 2010 were identified retrospectively and assessed for microbiological eradication, exacerbation frequency, hospital admissions, clinical symptoms and lung function. 30 patients were identified with median follow-up time 26.4 months. Eradication therapy involved intravenous antibiotics (n = 12), intravenous antibiotics followed by oral ciprofloxacin (n = 13) or ciprofloxacin alone (n = 5), combined with 3 months of nebulised colistin. Pseudomonas was initially eradicated from sputum in 24 patients (80.0%). 13/24 patients remained Pseudomonas-free and 11/24 were subsequently reinfected (median time 6.2 months). Exacerbation frequency was significantly reduced from 3.93 per year pre-eradication and 2.09 post-eradication (p = 0.002). Admission rates were similar, at 0.39 per year pre-eradication and 0.29 post-eradication (p = NS). 20/30 patients reported initial clinical improvement, whilst at one-year follow up, 19/21 had further improved or remained stable. Lung function was unchanged. This study demonstrates that Pseudomonas can be eradicated from a high proportion of patients, which may lead to prolonged clearance and reduced exacerbation rates. This important outcome requires confirmation in a prospective study.
Conclusions Results provide evidence that the levels of several prominent breath metabolites, which are potentially related to bacterial activity and lung injury, are significantly altered in patients with this disease. Breath analysis may therefore provide a novel, non-invasive and reliable strategy for the diagnosis of pneumonia. S129PREDICTING OUTCOME FROM HIV-ASSOCIATED PNEUMOCYSTIS PNEUMONIA Background The presentation of Pneumocystis jirovecii pneumonia (PCP) ranges from mild to severe. The former responds to antimicrobial therapy, the latter has a high mortality rate despite treatment. Several studies have described clinical and laboratory factors that are predictive of death from PCP. Our objectives were to create a prognostic scoring model to aid the clinician in predicting outcome from HIV-associated PCP. Methods A prognostic scoring model was built using risk factors identifiable at/soon after hospitalisation, that is, 'by the bedside'd which have previously been identified as being associated with mortality from PCP (a repeat episode of PCP, the patient's age, their haemoglobin (Hb), PaO 2 (breathing room air), both on admission, the presence of co-morbidity (Comorb), such as lymphoma or pregnancy, and the presence of pulmonary Kaposi sarcoma (PKS) (Walzer PD, et al CID 2008;46:625e33). The model was built from data concerning 592 consecutive episodes of PCP that had occurred among 540 patients presenting to a specialist inpatient HIV treatment centre.Results The prognostic scoring model was: [25.5 + (age in years/10) + 2 (if a repeat episode of PCP) + 4 (if PKS detected) + 4 (if Comorb present)ÀPaO 2 e Hb]. The prognostic model produced scores ranging from 0 to 20; median (IQR)¼9 (7e11). Testing interactions between risk factors and time showed the model to be applicable across all time periods. Patients were divided into five groups according to prognostic score: 0e3.9¼group 1, 4e7.9¼group 2, 8e11.9¼group 3, 12e15.9¼group 4, 16 or greater ¼group 5. Abstract S129 Table 1 shows mortality rates among the 540 patients with PCP, grouped according to their prognostic scores.Abstract S129 Table 1 Group Mortality (%) 1 0 2 3 3 1 3 4 2 9 5 5 9Conclusions While this prognostic scoring model requires further validation in patient cohorts from other healthcare institutions, it is potentially a simple 'by the bedside' method of identifying patients early in their hospital admission who are at high and low risk of in-hospital death from PCP and so may aid the clinician in assessing the severity of illness and in deciding on treatment strategies.
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