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Incidence and risk factors for pulmonary exacerbation treatment failures in cystic fibrosis patients chronically infected with Pseudomonas aeruginosa.
MedLine Citation:
PMID:  21835906     Owner:  NLM     Status:  Publisher    
Abstract INTRODUCTION: Pulmonary exacerbations (PEx) are responsible for much of the morbidity and mortality associated with cystic fibrosis (CF). However, there is a paucity of data on outcomes in CF PEx and factors influencing outcomes. METHODS: We reviewed all PEx in patients infected with P. aeruginosa treated with parenteral antibiotics over four years at our center. Treatment failures were a priori categorized as those PEx requiring antibiotic regimen change (ARC) or prolongation of therapy (POT) >20 days because of failure to respond, or an early recurrent event (ERE) within <45 days, or failure to recover lung function to >90% of baseline FEV(1) (FTR90). RESULTS: 101 patients were followed for 452 PEx. Treatment failures were observed in 125 (28%) of PEx; ARC 27 (6%), POT 29 (6%), ERE 63 (14%), and FTR90 66 (15%). Demographic factors associated with ≥ 1 treatment failure/year included; advanced airway disease, use of enteric feeds, CF-related diabetes and CF-liver disease but did not include female gender or F508del homozygosity. Increased treatment failure risk was associated with lower admission FEV(1) and increased markers of inflammation. At therapeutic completion, increased inflammatory markers correlated with treatment failure. Failure rates decreased with increasing number of active antimicrobial agents used based on in vitro susceptibility; zero 28/65 (43%), one 38/140 (27%), two 59/245 (24%) and three 0/2 (0%), p=0.02. CONCLUSIONS: One quarter of PEx fail to respond adequately to initial management. Patient demographic and episode specific clinical information can be used to identify individuals at increased risk of initial management failure.
Michael D Parkins; Jacqueline C Rendall; J Stuart Elborn
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-11
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Michael D. Parkins, MD MSc; Departments of Medicine and Microbiology and Infectious Disease, University of Calgary, Calgary AB, CANADA, and Northern Ireland Regional Adult Cystic Fibrosis Centre, Belfast City Hospital, Belfast, UNITED KINGDOM:
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