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Clinical Trial
. 2012 Sep;11(5):446-53.
doi: 10.1016/j.jcf.2012.04.003. Epub 2012 May 1.

Risk factors for age at initial Pseudomonas acquisition in the cystic fibrosis epic observational cohort

Margaret Rosenfeld  1 , Julia Emerson, Sharon McNamara, Valeria Thompson, Bonnie W Ramsey, Wayne Morgan, Ronald L Gibson; EPIC Study Group
Collaborators, Affiliations
Clinical Trial

Risk factors for age at initial Pseudomonas acquisition in the cystic fibrosis epic observational cohort

Margaret Rosenfeld et al. J Cyst Fibros. 2012 Sep.

Abstract

Background: Risk factors for initial Pseudomonas aeruginosa (Pa) acquisition, particularly environmental exposures, are poorly understood. We aimed to identify such risk factors in order to inform prevention strategies and identify high-risk populations.

Methods: The study cohort included all participants in the U.S. EPIC Observational Study who had no prior Pa-positive respiratory cultures (N=889). Cox proportional hazard models were used to test the effects of factors on age at first Pa-positive respiratory culture.

Results: Cystic fibrosis (CF) genotype functional class had an important effect on age at initial Pa acquisition (hazard ratio (HR) comparing minimal to residual CFTR function 2.87 (95% CI 1.88, 4.39)). None of the modifiable risk factors evaluated, including cigarette smoke, hot tub use, breastfeeding, or daycare, was associated with age at Pa acquisition. Similarly, newborn screening was not associated with age at Pa acquisition (HR 0.85, 95% CI 0.66, 1.09). Key associations were validated in a CF Foundation National Patient Registry replication cohort.

Conclusions: Given the ubiquitous presence of Pa in the environment, it may be that many imposed lifestyle changes will have less impact on age at initial Pa acquisition than genetic determinants.

Trial registration: ClinicalTrials.gov NCT00676169.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves for age at initial acquisition of Pseudomonas aeruginosa. a: EPIC observational cohort vs CFNPR replication cohort. b: Among EPIC Observational study participants, by CFTR functional class.
See this image and copyright information in PMC

References

    1. Rosenfeld M, Emerson J, Joubran K, Morgan W, Gibson R, for the EPIC Study Group Risk factors for early pseudomonas acquisition in a large cohort of young US CF patients. Pediatr Pulmonol. 2009;S32:373.
    1. Cystic Fibrosis Foundation. National Patient Registry 2010 Annual Data Report. Bethesda, Maryland: 2011.
    1. Kosorok MR, Zeng L, West SE, Rock MJ, Splaingard ML, Laxova A, et al. Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition. Pediatr Pulmonol. 2001;32(4):277–87. - PubMed
    1. Emerson J, Rosenfeld M, McNamara S, Ramsey B, Gibson RL. Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis. Pediatr Pulmonol. 2002;34(2):91–100. - PubMed
    1. Konstan MW, Morgan WJ, Butler SM, Pasta DJ, Craib ML, Silva SJ, et al. Risk factors for rate of decline in forced expiratory volume in one second in children and adolescents with cystic fibrosis. J Pediatr. 2007;151(2):134–9 [9 e1]. - PubMed

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