A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis
Background: Children with cystic fibrosis (CF) are susceptible to chronic Pseudomonas aeruginosa (PA) infection. Early eradication of PA has proven short-term efficacy. No studies have evaluated the long- term impact of early eradication for CF patients, particularly those diagnosed by newborn scree...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-08-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971219302334 |
| _version_ | 1818902436433100800 |
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| author | Fargol Mostofian Jamal Alkadri Kenneth Tang Nisha Thampi Dhenuka Radhakrishnan |
| author_facet | Fargol Mostofian Jamal Alkadri Kenneth Tang Nisha Thampi Dhenuka Radhakrishnan |
| author_sort | Fargol Mostofian |
| collection | DOAJ |
| description | Background: Children with cystic fibrosis (CF) are susceptible to chronic Pseudomonas aeruginosa (PA) infection. Early eradication of PA has proven short-term efficacy. No studies have evaluated the long- term impact of early eradication for CF patients, particularly those diagnosed by newborn screening (NBS). Our objective was to quantify the long-term impact of early PA eradication on the risk of chronic PA infection in children (0–18 years old) with CF prior to and following the introduction of a province-wide NBS program. Methods: This 20-year retrospective cohort study compared 94 patients eligible for treatment with inhaled tobramycin at first PA isolation (“recent cohort”) with 27 historical controls (“historical cohort”). Results: A smaller proportion of patients in the recent cohort developed chronic PA (24% versus 78%; P < 0.001); the adjusted risk of chronic infection was 2.90 (95%CI 1.47, 5.76; P = 0.002) in the historical vs recent cohort. However, NBS was not independently associated with the risk of chronic PA infection after its introduction. Conclusions: Early eradication of PA, irrespective of early diagnosis, is associated with reduced risk of chronic PA. However, concomitant improvements in medical care since the introduction of early eradication protocols may have contributed to these long-term observed benefits. Keywords: Child, Cystic fibrosis, Pseudomonas, Antibacterial agents, Early diagnosis |
| first_indexed | 2024-12-19T20:35:37Z |
| format | Article |
| id | doaj.art-3cd5ed77f8504f239b29c961598c3ffe |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-19T20:35:37Z |
| publishDate | 2019-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-3cd5ed77f8504f239b29c961598c3ffe2022-12-21T20:06:33ZengElsevierInternational Journal of Infectious Diseases1201-97122019-08-01859297A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosisFargol Mostofian0Jamal Alkadri1Kenneth Tang2Nisha Thampi3Dhenuka Radhakrishnan4Faculty of Medicine, University of Ottawa, Ottawa, Ontario, CanadaFaculty of Medicine, University of Ottawa, Ottawa, Ontario, CanadaChildren’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, CanadaFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, CanadaFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Corresponding author at: Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada.Background: Children with cystic fibrosis (CF) are susceptible to chronic Pseudomonas aeruginosa (PA) infection. Early eradication of PA has proven short-term efficacy. No studies have evaluated the long- term impact of early eradication for CF patients, particularly those diagnosed by newborn screening (NBS). Our objective was to quantify the long-term impact of early PA eradication on the risk of chronic PA infection in children (0–18 years old) with CF prior to and following the introduction of a province-wide NBS program. Methods: This 20-year retrospective cohort study compared 94 patients eligible for treatment with inhaled tobramycin at first PA isolation (“recent cohort”) with 27 historical controls (“historical cohort”). Results: A smaller proportion of patients in the recent cohort developed chronic PA (24% versus 78%; P < 0.001); the adjusted risk of chronic infection was 2.90 (95%CI 1.47, 5.76; P = 0.002) in the historical vs recent cohort. However, NBS was not independently associated with the risk of chronic PA infection after its introduction. Conclusions: Early eradication of PA, irrespective of early diagnosis, is associated with reduced risk of chronic PA. However, concomitant improvements in medical care since the introduction of early eradication protocols may have contributed to these long-term observed benefits. Keywords: Child, Cystic fibrosis, Pseudomonas, Antibacterial agents, Early diagnosishttp://www.sciencedirect.com/science/article/pii/S1201971219302334 |
| spellingShingle | Fargol Mostofian Jamal Alkadri Kenneth Tang Nisha Thampi Dhenuka Radhakrishnan A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis International Journal of Infectious Diseases |
| title | A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| title_full | A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| title_fullStr | A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| title_full_unstemmed | A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| title_short | A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| title_sort | real world evaluation of the long term efficacy of strategies to prevent chronic pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis |
| url | http://www.sciencedirect.com/science/article/pii/S1201971219302334 |
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