Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant organisms

Jennifer K Block ¹, Katherine L Vandemheen ¹, Elizabeth Tullis ², Dean Fergusson ¹, Steve Doucette ¹, David Haase ³, Yves Berthiaume ⁴, Neil Brown ⁵, Pearce Wilcox ⁶, Peter Bye ⁷, Scott Bell ⁸, Mary Noseworthy ⁹, Linda Pedder ¹⁰, Andreas Freitag ¹⁰, Nigel Paterson ¹¹ and Shawn D Aaron ^1*

¹ Ottawa Health Research Institute, Canada
² University of Toronto, Canada
³ Dalhousie University, Canada
⁴ Universite de Montreal, Canada
⁵ University of Alberta, Canada
⁶ University of British Columbia, Canada
⁷ The Woolcock Institute, Australia
⁸ The Prince Charles Hospital, Australia
⁹ Memorial University, Canada
¹⁰ McMaster University, Canada
¹¹ University of Western Ontario, Canada

^* To whom correspondence should be addressed. E-mail: saaron{at}ohri.ca.

Accepted 3 July 2006

Abstract

Background: This study examined characteristics of adult and adolescent cystic fibrosis patients to determine factors that would be associated with an increased risk of pulmonary exacerbations.

Methods: We recruited 249 cystic fibrosis patients who were infected with multi-drug resistant bacteria and prospectively followed them for up to 4.5 years until they experienced a pulmonary exacerbation severe enough to require intravenous antibiotics. Multivariable regression analyses were used to compare characteristics of patients who experienced an exacerbation with those who did not.

Results: Among the 249 patients, 124 (50%) developed a pulmonary exacerbation during the first year and 154 (62%) experienced an exacerbation during the 4.5 year study period. Factors predictive of exacerbations in a multivariable survival model were younger age (OR 0.98, 95% CI 0.96-0.99), female gender (OR 1.45, 95% CI 1.07-1.95), lower FEV1 (OR 0.98, 95% CI 0.97-0.99), and previous history of multiple pulmonary exacerbations (OR 3.16, 95% CI 1.93-5.17). Chronic use of inhaled corticosteroids was associated with an increased risk of exacerbation (OR 1.92, 95% CI 1.00-3.71) during the first study year.

Conclusions: Patients who experience pulmonary exacerbations are more likely to be younger, female, using inhaled steroids, have a lower FEV1 and a history of multiple previous exacerbations. Knowledge of these risk factors will allow better identification and closer monitoring of patients who are at high risk of exacerbations.

Keywords: cystic fibrosis, lung infections, pulmonary exacerbations, risk factors

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