Longtitudinal study providing unique information on risk factors for new and recurrent Pseudomonas (Pa) infection
•
Accurate identification of Pa in lower airways.
•
Identification of children most at risk may help tailor prevention strategies to avoid recurrent and, subsequently, chronic Pa infection.
•
This study shows that geographical location and climate are associated with risk of recurrent Pa infection.
Abstract
Objectives
To determine the association between residence and climate with risk of Pseudomonas aeruginosa (Pa) and other respiratory outcomes.
Methods
We performed regular bronchoalveolar lavage and upper airway cultures in young children with CF to identify Pa infection. Children were classified for residence as regional or metropolitan. Bronchiectasis was detected on periodic chest computed tomography scans. Multilocus sequence typing determined Pa genotype. Lung function was assessed using Multiple Breath Washout.
Results
Of infants diagnosed with CF between 2006 and 2017, 129 were included in the study. Seven patients moved between metropolitan and regional Victoria and were excluded from analysis. Of the remaining 122 subjects, seventy-four (61%) children resided in metropolitan areas and over half (54%) were male. There were 83 Pa episodes in the 122 children who lived consistently in a geographical location. The incidence rate was 0.15 episodes per person-years. We found weak evidence of a 15% increase in the rate of Pa episodes with increasing average annual maximum temperature (95%CI (0.98, 1.36); p = .086), while the rate of Pa acquision decreased with average annual 3 pm humidity (IRR = 0.96; 95%CI(0.92, 1.0008); p = .054). The rate of Pa episodes was 2.1 times higher in regional participants (95%CI (1.4, 3.1); p = .001) and risk of second episode was more than five times greater (HR 5.7; 95%CI 1.9, 17); p = .002). No difference between regions in lung clearance index and presence of bronchiectasis was detected.
Conclusion
Regional residence is associated with risk of acquiring recurrent infection with Pseudomonas aeruginosa in young children with CF.