Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients

Lee, Tim W. R.; Brownlee, K.; Conway, S.P.; Denton, M.; Littlewood, J M

doi:10.1016/s1569-1993(02)00141-8

Cited by 609 publications

(602 citation statements)

References 20 publications

(1 reference statement)

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“…Patients were randomly selected and categorized as follows: (i) active patients, i.e., patients who were being monitored and managed for chronic P. aeruginosa infection at the time of study; (ii) transferred patients, i.e., those who had left the care of our clinic and moved to an area outside southern Alberta; and (iii) patients who experienced end-stage CF lung disease and either succumbed to CF or received lung transplantation. Chronic infection was defined per the Leeds criteria (19). A distinct morphotype of P. aeruginosa was defined a priori as a macroscopically distinct colony type on MacConkey agar.…”

Section: Methodsmentioning

confidence: 99%

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

et al. 2014

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Transmissible strains of Pseudomonas aeruginosa have been described for cystic fibrosis (CF) and may be associated with a worse prognosis. Using a comprehensive strain biobank spanning 3 decades, we sought to determine the prevalence and stability of chronic P. aeruginosa infection in an adult population. P. aeruginosa isolates from sputum samples collected at initial enrollment in our adult clinic and at the most recent clinic visit were examined by a combination of pulsed-field gel electrophoresis and multilocus sequence typing and compared against a collection of established transmissible and local non-CF bronchiectasis (nCFB) isolates. A total of 372 isolates from 107 patients, spanning 674 patient-years, including 66 patients with matched isolates from initial and final encounters, were screened. A novel clone with increased antibacterial resistance, termed the prairie epidemic strain (PES), was found in 29% (31/107 patients) of chronically infected patients referred from multiple prairie-based CF centers. This isolate was not found in those diagnosed with CF as adults or in a control population with nCFB. While 90% (60/66 patients) of patients had stable infection over a mean of 10.8 years, five patients experienced strain displacement of unique isolates, with PES occurring within 2 years of transitioning to adult care. PES has been present in our cohort since at least 1987, is unique to CF, generally establishes chronic infection during childhood, and has been found in patients at the time of transition of patients from multiple prairie-based CF clinics, suggesting broad endemicity. Studies are under way to evaluate the clinical implications of PES infection.

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Section: Methodsmentioning

confidence: 99%

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

et al. 2014

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“…Chronic colonization was defined by the isolation of potentially pathogenic bacteria in sputum culture on two or more occasions, at least 3 months apart in a 1-year period (14,16,17). The predominant pathogen was the organism grown most frequently over the study period.…”

Section: Bacteriologymentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

816

836

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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“…32,33 In the younger children the definition of chronic colonization by PA were based on Leeds criteria. 25 The validity of this definition has recently been confirmed. 34 The minimum sample number needed to use the Leeds criteria for a given year should be four.…”

Section: Pediatric Pulmonologymentioning

confidence: 89%

“…25 In the older siblings less than 4 sputum samples per year were available. In these patients the old…”

Section: Methodsmentioning

confidence: 99%

Long‐term effects of birth order and age at diagnosis in cystic fibrosis: A sibling cohort study

Slieker

Berg

Kouwenberg

et al. 2010

Pediatric Pulmonology

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An infection after allogeneic stem cell transplantation (SCT) can affect the activity of immune cells and increase the level of proinflammatory cytokines. Further, a post‐SCT infection may influence the milieu of the graft‐versus‐leukemia (GVL) effect and graft‐versus‐host disease (GVHD). We performed a retrospective study of patients with acute leukemia who had undergone allogeneic SCT using the same preparative regimens and bone marrow as the stem cell source to determine if early post‐transplant infection was associated with the risk of leukemic relapse and GVHD. The analysis revealed that patients who had a febrile infection (FI) before post‐transplant day 21 (FI group) had a lower actuarial probability of leukemic relapse (P < 0.001) and a higher relapse‐free survival rate (P = 0.012) than those patients who did not have a FI before post‐transplant day 21 (non‐FI group). The experience of early post‐transplant FI (HR = 0.316; 95% CI = 0.174–0.575; P < 0.001), together with the presence of chronic GVHD and high risk cytogenetics, were independent predictive factors for post‐transplant leukemic relapse. The FI group had a trend towards a higher lymphocyte count on post‐transplant day 21 than the non‐FI group (P = 0.063), despite the delayed recovery of the platelet count and a trend towards delayed recovery of the neutrophil count. These findings suggest that a change in the immunologic network by infectious diseases in the early post‐transplant period favors the milieu of the GVL effect. The specific immunologic change during FI, which can potentiate the GVL effect, remains to be determined. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.

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Evaluation of a new definition for chronic Pseudomonas aeruginosa infection in cystic fibrosis patients

Abstract: The validity and importance of identifying these four subgroups is demonstrated. Previous definitions may over-estimate the prevalence of chronic infection.

Cited by 609 publications

References 20 publications

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Long‐term effects of birth order and age at diagnosis in cystic fibrosis: A sibling cohort study

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