Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

Abstract

The rate of diagnosis of colonization/infection of the airways with Achromobacter xylosoxidans has increased in cystic fibrosis patients, but its clinical significance is still controversial. This retrospective, case-control study aimed to evaluate the clinical impact of A. xylosoxidans colonization/infection in cystic fibrosis patients. Individuals who were chronically colonized/infected (n=10), intermittently colonized/infected (n=15), and never colonized/infected with A. xylosoxidans (n=18) were retrospectively evaluated during two periods that were 2 years apart. Demographic characteristics, clinical data, lung function, and chronic bacterial co-colonization data were evaluated. Of the total study population, 87% were pediatric patients and 65.1% were female. Individuals chronically colonized/infected with A. xylosoxidans had decreased forced expiratory volume in 1 s (51.7% in the chronic colonization/infection group vs 82.7% in the intermittent colonization/infection group vs 76% in the never colonized/infected group). Compared with the other two groups, the rate of co-colonization with methicillin-resistant Staphylococcus aureus was higher in individuals chronically colonized/infected with A. xylosoxidans (P=0.002). Changes in lung function over 2 years in the three groups were not significant, although a trend toward a greater decrease in lung function was observed in the chronically colonized/infected group. Compared with the other two groups, there was a greater number of annual hospitalizations in patients chronically colonized/infected with A. xylosoxidans (P=0.033). In cystic fibrosis patients, there was an increased frequency of A. xylosoxidans colonization/infection in children, and lung function was reduced in patients who were chronically colonized/infected with A. xylosoxidans. Additionally, there were no differences in clinical outcomes during the 2-year period, except for an increased number of hospitalizations in patients with A. xylosoxidans.

Figure 1. Distribution of chronic co-colonization according to the following groups: group I, chronic colonization/infection with A. xylosoxidans and chronic colonization with P. aeruginosa; group II, intermittent colonization/infection with A. xylosoxidans and chronic colonization with P. aeruginosa; and group III, never colonized/infected with A. xylosoxidans, but chronically colonized with P. aeruginosa. A significant difference in chronic co-colonization with methicillin-resistant S. aureus (MRSA) was found among the three groups (P=0.002; significant difference was observed between groups I and III using Fisher's exact test set for each peer group separately). No significant difference was observed for other types of chronic colonization.