Format

Send to

Choose Destination
See comment in PubMed Commons below
Pediatr Pulmonol. 2012 Feb;47(2):125-34. doi: 10.1002/ppul.21525. Epub 2011 Aug 9.

Initial Pseudomonas aeruginosa treatment failure is associated with exacerbations in cystic fibrosis.

Collaborators (253)

Beall RJ, Campbell PW 3rd, Marshall BC, Carter R, Gabbert W, Grantham E, Khan A, Klein D, Smith K, Stone J, Services CF, Arnold M, Crilly E, Jennings P, Leong K, Sullivan M, Van Etten B, Quittell L, Clarke WR, Kennedy MJ, Nelson RM, Olivier KN, Rubenstein RC, Williams O, Weinmann GG, Banks-Schlegel S, Joo J, Retsch-Bogart G, Banks-Schlegel S, Beall RJ, Campbell PW, Gibson RL, Graff GR, Hershey MS, Gutierrez HH, Kanga J, Kronmal R, Kuhn R, Lahiri T, Mayer-Hamblett N, McKeon C, Morgan W, Noyes BE, Ramsey BW, Rosenfeld M, Saiman L, Schechter M, Stokes DC, Wagener JS, Williams J, Woo M, Andrina M, Cassano K, Castro C, Chambers D, Feldman A, Hill R, Potter T, Velde S, Desmon S, Nelson A, Williams J, Fogarty B, Escobar D, Mathewson B, White T, Khan U, Lymp J, Mayer-Hamblett N, Cohen M, Beamer J, Clements L, Hovick G, Kruesel C, Seefried D, Wharton A, Beauchene N, Van Housen L, Larson L, Crist D, Fitzpatrick C, Singleton S, Quong G, Buccat AM, Burns J, Stapp J, Goss C, Hough T, Kraynack NC, Omlor G, Spoonhower KA, Ouellette DA, Comber PG, Laskoski S, Pursel J, duPont AI, Chidekel A, Budd SM, Gondor M, Lehmann S, Flanary J, Spencer LT, Waltz DA, Adams S, Leone E, Keens T, Platzker AC, Ortego R, Abdulhamid I, Toder D, Van Wagnen C, Orenstein D, Fulton J, Hurban S, Gershan W, Miller T, McNamara J, Pryor M, Landvik S, Sachs M, Prestridge A, VandenBranden S, Black P, Bear L, Matzedar M, Robinson K, Dyson MC, Schultz KD, Scott S, Parker H, Felicetti N, Schechter MS, Peabody J, Miller S, Kizer I, Millard SL, Schuen JN, Howenstine M, Crumb TL, Symington T, Barclay T, Shay G, Lee J, Seastrand M, Moss R, Dunn C, Davies Z, Cairns AM, Mellow T, Messitt T, Corrigan ME, Lapey A, Saulnier D, Guill F, McKie K, Evans C, O'Donnell N, Hall J, Dyer K, Adler-Shohet F, Zanni RL, Marra B, McCoy KS, Raterman L, Schaeffer DA, Pingel DL, Sprinkle RA, Amin N, Boyer JT, Dozor AJ, Gherson I, Wall M, Guzik A, McNamara S, Konstan M, Bucur C, Ferkol T, Velotta C, Gibson RL, Rosenfeld M, Varlotta L, Bonitz L, Gambo J, Overcash J, Burks P, Quante J, Noyes BE, Kociela VL, DeCelie-Germana J, Anbar RD, Linder DM, Suttmore VN, Hiatt PW, Hallmark C, Accurso FJ, Wagener JS, Mann SA, Fink RJ, Mueller GA, Bartosik SR, Royce FH, Mogayzel PJ, Zeitlin PL, Callahan KA, Chapman CG, Graff GR, Schwartz MS, Allwein LM, Kitch DM, Gutierrez HH, Britton L, Tarn VE, Sabbatini G, Nielson DW, Ahrens RC, Frauenholtz J, Huey L, Teresi M, Anstead MI, Kanga JF, Dudderar C, Owsley B, O'Sullivan BP, Baker D, Nasr SZ, Kruse D, Adcock K, Ruiz F, Barfield K, Colombo J, Acquazzino D, Retsch-Bogart G, Barlow C, Callahan T, Towle D, Ren CL, Dixon M, Schoumacher RA, Culbreath BA, Knight M, Ampofo K, Chatfield B, Uchida D, Griffiths S, Froh DK, Kelly R, Rock MJ, Harris C, Perkett E, Bray A, Lahiri T, Diehl S, Keller E.

Author information

1
Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington, USA. nicole.hamblett@seattlechildrens.org

Abstract

RATIONALE:

The risk of pulmonary exacerbation following Pseudomonas aeruginosa (Pa) acquisition in children with cystic fibrosis (CF) is unknown.

OBJECTIVES:

To determine if failure of antibiotic therapy to eradicate Pa and frequency of Pa recurrence are associated with increased exacerbation risk.

METHODS:

The cohort included 282 children with CF who participated in the EPIC trial ages 1-12 with newly acquired Pa, defined as either a first lifetime Pa positive respiratory culture or positive after two years of negative cultures (past isolation of Pa but >2 years prior to the trial). All received antibiotics to promote initial eradication followed by 15 months of intermittent maintenance antibiotics. Quarterly cultures were used to define initial eradication success and subsequent number of Pa recurrences. A standardized symptom-based definition of exacerbation was utilized. Cox proportional hazards models were used to estimate exacerbation risk.

RESULTS:

Failure to initially eradicate Pa was associated with exacerbation risk (hazard ratio [HR]: 2.49, 95% confidence interval [CI] 1.26, 4.93). In 245/282 with successful initial eradication during the trial, past isolation of Pa >2 years before the trial was the most significant predictor of exacerbation (HR 1.62, 95% CI 1.12, 2.35). In 37/282 who failed initial eradication, persistent Pa during the maintenance phase (1 or more Pa recurrences after failure to initially eradicate) added even greater exacerbation risk (HR 4.13, 95% CI 1.28, 13.32).

CONCLUSIONS:

Children with CF who fail to eradicate after initial antibiotic treatment are at higher risk of subsequent exacerbation, suggesting clinical benefit to successful early eradication of Pa infection.

PMID:
21830317
PMCID:
PMC3214247
DOI:
10.1002/ppul.21525
[Indexed for MEDLINE]
Free PMC Article

Publication types, MeSH terms, Substances, Grant support

Publication types

MeSH terms

Substances

Grant support

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Wiley Icon for PubMed Central
    Loading ...
    Support Center