PT  - JOURNAL ARTICLE
AU  - Sabariah Noor Harun
AU  - Nicholas H G Holford
AU  - Keith Grimwood
AU  - Claire E Wainwright
AU  - Stefanie Hennig
ED  - ,
TI  - <em>Pseudomonas aeruginosa</em> eradication therapy and risk of acquiring <em>Aspergillus</em> in young children with cystic fibrosis
AID  - 10.1136/thoraxjnl-2018-211548
DP  - 2019 Aug 01
TA  - Thorax
PG  - 740--748
VI  - 74
IP  - 8
4099  - http://thorax.bmj.com/content/74/8/740.short
4100  - http://thorax.bmj.com/content/74/8/740.full
SO  - Thorax2019 Aug 01; 74
AB  - Background While Aspergillus detection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown.Aim To determine the risk and explanatory factors of acquiring Aspergillus in children with CF by age 5 years.Methods Cross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detecting Aspergillus at age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiring Aspergillus and Pseudomonas aeruginosa from birth until age 5 years.Results Cross-sectional analysis found that the number of P. aeruginosa eradication courses increased the odds of detecting Aspergillus at age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the first P. aeruginosa positive culture was 2.38 (1.32–3.79) years and 3.69 (1.68–4.74) years for the first Aspergillus positive culture. The risk of P. aeruginosa and Aspergillus events changes with time after the first year of study entry. It also decreases for P. aeruginosa after completing P. aeruginosa eradication (HR 0.15, 95% CI 0.00 to 0.79), but increases for Aspergillus events (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event.Conclusion In young children with CF, completing P. aeruginosa eradication therapy and previous Aspergillus events are associated with increased risk of acquiring Aspergillus.