Age of Pseudomonas aeruginosa acquisition and subsequent severity of cystic fibrosis lung disease
Corresponding Author
Jessica E. Pittman MD, MPH
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, 130 Mason Farm Rd., CB# 7217, Chapel Hill, North Carolina 27599, USA.Search for more papers by this authorElizabeth H. Calloway BA
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMichelle Kiser MD
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorJohn Yeatts BA
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorStephanie D. Davis MD
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMitchell L. Drumm PhD
Department of Pediatrics, Case Western Reserve University
Search for more papers by this authorMichael S. Schechter MD, MPH
Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Cleveland, Ohio
Search for more papers by this authorMargaret W. Leigh MD
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMary Emond PhD
Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
Search for more papers by this authorAnnelies Van Rie MD, PhD
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMichael R. Knowles MD
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorCorresponding Author
Jessica E. Pittman MD, MPH
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, 130 Mason Farm Rd., CB# 7217, Chapel Hill, North Carolina 27599, USA.Search for more papers by this authorElizabeth H. Calloway BA
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMichelle Kiser MD
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorJohn Yeatts BA
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorStephanie D. Davis MD
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMitchell L. Drumm PhD
Department of Pediatrics, Case Western Reserve University
Search for more papers by this authorMichael S. Schechter MD, MPH
Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Cleveland, Ohio
Search for more papers by this authorMargaret W. Leigh MD
Department of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMary Emond PhD
Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
Search for more papers by this authorAnnelies Van Rie MD, PhD
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorMichael R. Knowles MD
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
Search for more papers by this authorAbstract
Rationale
Pseudomonas aeruginosa (Pa) is associated with poor pulmonary outcomes in cystic fibrosis (CF), but the association between age of Pa infection and severity of subsequent lung disease has not been thoroughly investigated.
Objective
Our goal was to determine the association between age of Pa acquisition and subsequent severity of CF lung disease.
Methods
Case–control study using CF Foundation Registry data of 629 ΔF508 homozygotes with severe and mild lung disease (FEV1 in the lowest and highest quartile of birth cohort, respectively). Multivariate logistic regression was performed to determine the association between age of Pa acquisition and lung disease severity.
Results
Earlier age of Pa infection was strongly associated with increased odds of severe lung disease. For first and persistent Pa, adjusted odds ratios for severe lung disease were 6.5 (95% CI 3.1, 13.7; P < 0.0001) and 11.2 (5.4, 23.1; P < 0.0001), respectively, for subjects with infection before age 5 versus at ≥10 years; the association was stronger in females than males.
Conclusions
Earlier Pa infection, particularly before 5 years of age, is strongly associated with severe CF lung disease later in life. This study is not designed to determine causality; Pa infection may be causing lung injury, or may be a marker of ongoing inflammation and lung damage in young children with CF. Pediatr. Pulmonol. 2011; 46:497–504. © 2010 Wiley-Liss, Inc.
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