Format

Send to

Choose Destination
PLoS One. 2016 Nov 18;11(11):e0166220. doi: 10.1371/journal.pone.0166220. eCollection 2016.

Factors Associated with Worse Lung Function in Cystic Fibrosis Patients with Persistent Staphylococcus aureus.

Author information

1
Clinic for Paediatric Pulmonology, Allergology and Neonatology, Hannover, Hannover, Germany.
2
Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany.
3
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
4
Institute of Medical Informatics and Biometrics, Technical University Dresden, Dresden, Germany.
5
Clinical Research Group, Clinic for Paediatric Pulmonology, Allergology and Neonatology, Medizinische Hochschule Hannover, Hannover, Germany.
6
CF-Center Innsbruck, Department of Child and Adolescent Health, Medical University of Innsbruck, Innsbruck, Austria.
7
Department of Paediatrics, University Hospital Münster, Münster, Germany.
8
Department of Paediatrics, Clemenshospital Münster, Münster, Germany.
9
Ruhr University, Paediatric Clinic at St Josef Hospital, Bochum, Germany.
10
Department of Paediatrics, University Hospital Essen, Essen, Germany.
11
Paediatricians "Kinderärztliche Ambulanz", Hamburg, Germany.
12
CF Center, Department of Paediatrics, Jena University Hospital, Jena, Germany.
13
Department of Paediatrics, University Clinics Dresden, Dresden, Germany.
14
Department of Pediatrics, University Clinics Tübingen, Tübingen, Germany.
15
Department of Paediatric Pulmonology and Immunology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
16
University Hospital Halle, Halle, Germany.
17
Children's Hospital Osnabrück, Osnabrück, Germany.
18
Department of Paediatrics, University of Düsseldorf, Düsseldorf, Germany.
19
Park Schönefeld Clinics, Kassel, Germany.
20
Ruhrlandklinik, Essen, Germany.
21
University Clinics Leipzig, Leipzig, Germany.
22
Center for Laboratory Medicine, University Hospital Münster, Münster, Germany.
23
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.

Abstract

BACKGROUND:

Staphylococcus aureus is an important pathogen in cystic fibrosis (CF). However, it is not clear which factors are associated with worse lung function in patients with persistent S. aureus airway cultures. Our main hypothesis was that patients with high S. aureus density in their respiratory specimens would more likely experience worsening of their lung disease than patients with low bacterial loads.

METHODS:

Therefore, we conducted an observational prospective longitudinal multi-center study and assessed the association between lung function and S. aureus bacterial density in respiratory samples, co-infection with other CF-pathogens, nasal S. aureus carriage, clinical status, antibiotic therapy, IL-6- and IgG-levels against S. aureus virulence factors.

RESULTS:

195 patients from 17 centers were followed; each patient had an average of 7 visits. Data were analyzed using descriptive statistics and generalized linear mixed models. Our main hypothesis was only supported for patients providing throat specimens indicating that patients with higher density experienced a steeper lung function decline (p<0.001). Patients with exacerbations (n = 60), S. aureus small-colony variants (SCVs, n = 84) and co-infection with Stenotrophomonas maltophilia (n = 44) had worse lung function (p = 0.0068; p = 0.0011; p = 0.0103). Patients with SCVs were older (p = 0.0066) and more often treated with trimethoprim/sulfamethoxazole (p = 0.0078). IL-6 levels positively correlated with decreased lung function (p<0.001), S. aureus density in sputa (p = 0.0016), SCVs (p = 0.0209), exacerbations (p = 0.0041) and co-infections with S. maltophilia (p = 0.0195) or A. fumigatus (p = 0.0496).

CONCLUSIONS:

In CF-patients with chronic S. aureus cultures, independent risk factors for worse lung function are high bacterial density in throat cultures, exacerbations, elevated IL-6 levels, presence of S. aureus SCVs and co-infection with S. maltophilia.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00669760.

PMID:
27861524
PMCID:
PMC5115705
DOI:
10.1371/journal.pone.0166220
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center