Aaron, Shawn D., Vandemheen, Katherine L., Ramotar, Karam, Giesbrecht-Lewis, Tracy, Tullis, Elizabeth, Freitag, Andreas, Paterson, Nigel, Jackson, Mary, Lougheed, M. Diane, Dowson, Christopher G., Kumar, Vijay, Ferris, Wendy, Chan, Francis, Doucette, Steve and Fergusson, Dean. (2010) Infection with transmissible strains of pseudomonas aeruginosa and clinical outcomes in adults with cystic fibrosis. JAMA: The Journal of the American Medical Association, Vol.304 (No.19). pp. 2145-2153. ISSN 0098-7484

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Abstract

Context Studies from Australia and the United Kingdom have shown that some patients with cystic fibrosis are infected with common transmissible strains of Pseudomonas aeruginosa. Objectives To determine the prevalence and incidence of infection with transmissible strains of P aeruginosa and whether presence of the organism was associated with adverse clinical outcomes in Canada. Design, Setting, and Participants Prospective observational cohort study of adult patients cared for at cystic fibrosis clinics in Ontario, Canada, with enrollment from September 2005 to September 2008. Sputum was collected at baseline, 3 months, and yearly thereafter for 3 years; and retrieved P aeruginosa isolates were genotyped. Vital status (death or lung transplant) was assessed for all enrolled patients until December 31, 2009. Main Outcome Measures Incidence and prevalence of P aeruginosa isolation, rates of decline in lung function, and time to death or lung transplantation. Results Of the 446 patients with cystic fibrosis studied, 102 were discovered to be infected with 1 of 2 common transmissible strains of P aeruginosa at study entry. Sixty-seven patients were infected with strain A (15%), 32 were infected with strain B (7%), and 3 were simultaneously infected with both strains (0.6%). Strain A was found to be genetically identical to the Liverpool epidemic strain but strain B has not been previously described as an epidemic strain. The incidence rate of new infections with these 2 transmissible strains was relatively low (7.0 per 1000 person-years; 95% confidence interval [CI], 1.8-12.2 per 1000 person-years). Compared with patients infected with unique strains of P aeruginosa, patients infected with the Liverpool epidemic strain (strain A) and strain B had similar declines in lung function (difference in decline in percent predicted forced expiratory volume in the first second of expiration of 0.64% per year [95% CI, -1.52% to 2.80% per year] and 1.66% per year [95% CI, -1.00% to 4.30%], respectively). However, the 3-year rate of death or lung transplantation was greater in those infected with the Liverpool epidemic strain (18.6%) compared with those infected with unique strains (8.7%) (adjusted hazard ratio, 3.26 [95% CI, 1.41 to 7.54]; P = .01). Conclusions A common strain of P aeruginosa (Liverpool epidemic strain/strain A) infects patients with cystic fibrosis in Canada and the United Kingdom. Infection with this strain in adult Canadian patients with cystic fibrosis was associated with a greater risk of death or lung transplantation. JAMA, 2010;304(19):2145-2153 www.jama.com

Item Type:	Journal Article
Subjects:	R Medicine
Divisions:	Faculty of Science > Life Sciences (2010- )
Journal or Publication Title:	JAMA: The Journal of the American Medical Association
Publisher:	American Medical Association
ISSN:	0098-7484
Date:	17 November 2010
Volume:	Vol.304
Number:	No.19
Number of Pages:	9
Page Range:	pp. 2145-2153
Identification Number:	10.1001/jama.2010.1665
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Canadian Institutes of Health Research, Canadian Cystic Fibrosis Foundation, Ontario Thoracic Society
URI:	http://wrap.warwick.ac.uk/id/eprint/4852

Data sourced from Thomson Reuters' Web of Knowledge

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