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67 CF patients with a declining FEV1: At risk for acquisition of Burkholderia cepacia complex infection?
S74
4. Microbiology
Posters
65 Clinical outcomes of chronic “Prairie Epidemic Strain” Pseudomonas aeruginosa infection in adults with cystic fibrosis
67 CF patients with a declining FEV1 : At risk for acquisition of Burkholderia cepacia complex infection?
R. Somayaji1 , J. Lam1 , M. Surette2 , B. Waddell3 , S. Purighalla3 , C. Sibley1 , H.R. Rabin3 , M.D. Parkins3 . 1 University of Calgary, Calgary, Canada; 2 McMaster University, Department of Medicine, Hamilton, Canada; 3 University of Calgary, Department of Microbiology, Immunology and Infectious Diseases, Calgary, Canada
J. Willekens1 , S. Wanyama2 , M. Thomas2 , E. De Wachter1 , I. De Schutter1 , A. Malfroot1 . 1 Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Department of Pediatrics, Cystic Fibrosis Clinic, Brussels, Belgium; 2 Scientific Institute of Public Health WIV-ISP, Public Health and Surveillance, Brussels, Belgium
Objective: Transmissible Pseudomonas aeruginosa (PA) strains have been described in CF and may be associated with a poorer prognosis. The “Prairie Epidemic Strain” (PES) has been recently identified in up to 30% of patients at prairie-based CF centres, however, its clinical impact remains to be determined. Methods: A cohort study of adults with cystic fibrosis from 1981–2014 was conducted and all PA isolates from clinical visits were prospectively collected. PA strain typing at clinic enrolment, and most recent was conducted by PFGE. Patients were divided into one of four cohorts: no PA, transient PA, unique chronic PA, and chronic PES. Random effects and proportional Cox hazard models were conducted for outcome of death, transplantation and FEV1% decline. Results: 204 patients (54% male) with CF were analysed: 38 no PA, 20 transient PA, 103 unique PA, 43 PES. Baseline FEV1% was lowest in the chronic PES group (p = 0.002). Overall rate of FEV1% decline was −1.19%/year (95% CI: −1.41 to −0.97, p < 0.001); the chronic PES group had the greatest rate of decline at −1.24%/year (p < 0.001). There were a total of 42 deaths and 37 transplants through 1862 and 2050 follow-up years, respectively. The age-adjusted hazard ratio (HR) for death was not different for the PA groups compared to the no PA group. Relative to the no PA group, risk of transplant was increased in those with chronic PES (HR 9.13, CI 1.29−69, p = 0.032) compared to the no PA group. Conclusion: Chronic PES infection is significantly associated with a greater rate of FEV1% decline and risk of lung transplantation but not with increased risk of death compared to no PA infection.
Introduction: Burkholderia cepacia complex (Bcc) infection is considered to be associated with worsening of CF lung disease. Patient to patient spread has been reported, however mechanisms of acquisition of Bcc are not well understood. Method: Data from the Belgian CF Registry (year 2000–2010) were collected. Inclusions: Bcc infected patients with entries on lung function in at least 1 y before and 3 y after Bcc acquisition. For each case, we included 2 controls, matched for age at the index year (year of first Bcc infection), pancreatic status, sex. Cumulative data up to 2 years before index year were compared to values obtained after infection using Rank sum test. Rate of decline in lung function was adjusted for baseline lung function, age, sex. Results: Bcc prevalence in CF is low in Belgium (<3%). 183 patients were included: 61 cases, 122 controls. 59% were F508del homozygous. Mean age in cases was 20.9 y (SD 10.5) vs 20.3 y (SD 10.3) in controls. Among the Bcc, 54% were unspecified, 31% were B. multivorans. Mean FEV1 at index year was 65.2% (SD 24.9) in cases vs 73.1 (SD 26.9) in controls (p = 0.07). FEV1 decline before index year was significantly higher in cases (−1.7%, SD 0.5) compared to controls (−1.0%, SD 0.3) (p = 0.002). FEV1 slopes were comparable in the period after index year (−1.1%, SD 0.5, in cases vs −0.99%, SD 0.4, p = 0.24). Conclusion: Our results suggest that a declining FEV1 precedes acquisition of Bcc and may be a risk factor. After acquisition, lung function decline was comparable in Bcc infected and uninfected patients. These results should be interpreted with caution, since registry data are collected retrospectively and bear a risk of incompleteness or inaccuracy.
66 Incidence of Burkholderia cepacia complex infection in a Cystic Fibrosis Centre in Buenos Aires City, Argentina, from 2004 to 2014 L. Ibarra1 , J. Degrossi2 , L. Jord´a Vargas2 , P. Barrero1 , M. Vazquez1 , A. Teper1 , L. Galanternik1 . 1 Hospital de Ni˜nos Ricardo Gutierrez, Buenos Aires, Argentina; 2 Universidad de Buenos Aires, Facultad de Farmacia y Bioqu´ımica, Buenos Aires, Argentina Burkholderia cepacia complex (Bcc) is recognized as a significant respiratory pathogen in Cystic Fibrosis (CF) patients. The identification at species level among the 18 established Bcc members is an essential tool for epidemiological studies and infection control policies. In the early 2000s the epidemiology of Burkholderia cepacia (Bcc) in Argentina was characterized by the occurrence of a B. contaminans outbreak that took place in major CF centres. This situation was quite different from other countries where B. cenocepacia and B. multivorans have been the most frequent Bcc infecting species in CF patients. Although B. contaminans outbreak was studied, little is known about the evolution of Bcc epidemiology during the last years. The aim of this study was to analyse Bcc infections in CF patients (pt) attending Hospital de Ni˜nos “R. Guti´errez” in 3 different periods between 2004 and 2014. Incidence and distribution of Bcc species have been described. 2004–2005: Incidence 13.5% (22/163 pt). B. contaminans 55.6% (10/18), B. cepacia 16.7% (3/18), B. cenocepacia and B. seminalis 11.1% (2/18), B. multivorans 5.6% (1/18), 4 nonviable strains. 2007–2009: Incidence 6.6% (12/181 pt). B. contaminans 72.7% (8/11), B. cepacia 27.3% (3/11), 1 nonviable strain. 2012–2014: Incidence 5.4% (10/184 pt). B. contaminans 90% (9/10), B. cepacia 10% (1/10). Conclusions: B. contaminans remains the most frequent isolated species among the new cases of infection. Although incidence values have decreased, these results suggest the situation with B. contaminans hasn’t been solved yet. More studies specially focusing on the transmission of these bacteria and the possible sources of infection are needed.
68 Respiratory viral detection in children with cystic fibrosis (CF) I. Tjeˇsi´c-Drinkovi´c1 , S. Ljubin-Sternak1,2 , J. Vraneˇs1,2 , D. Tjeˇsi´c-Drinkovi´c1,3 . 1 University of Zagreb-School of Medicine, Zagreb, Croatia; 2 Dr. A. Stampar ˇ Institute of Public Health, Zagreb, Croatia; 3 University Hospital Centre Zagreb, Department of Pediatrics − CF Unit, Zagreb, Croatia Objectives: The aim of this study was to assess the presence of respiratory viruses in CF patients at routine visits during the two-month period (November-December 2014) and to determine the clinical impact of this finding. Methods: Nasopharyngeal swabs/aspirates from 35 patients were tested using a PCR method (Serplex® RV15 Onestep ACE Detection), detecting 15 respiratory viruses (adenovirus, coronavirus 229E/NL63 and OC43, parainfluenza virus 1, 2, 3 and 4, influenza A and B, respiratory syncytial virus A and B, rhinovirus (RV), metapneumovirus, boccavirus and enterovirus). Results: Patients were 2−24 yrs old (AVR 12 y), 13 chronically colonised with Pseudomonas aeruginosa (PA). Lung function test for 30 subjects showed: 9 normal findings; 11 mild, 7 moderate and 3 severe lung disease. There was no significant difference regarding lung function or PA status between the subgroups of patients positive or negative for viruses. Viruses were detected in 4/35 subjects (2 RV, 1 enterovirus, 1 parainfluenza virus 3) and 3 had concomitant PA isolation (1 chronic colonisation). However, no acute worsening of the respiratory status was found, determined as the presence of fever and upper respiratory symptoms or a recent change in at least two of the following: sputum volume or colour, cough intensity, increased malaise, increased dyspnea, loss of appetite, a decrease of FEV1 >10% (modified Fuchs criteria). Conclusion: In this pilot study chronic PA infection wasn’t associated with a higher rate of viral detection and no immediate negative consequences of virus detection on the respiratory status of CF patients was observed. Further study is needed.
4. Microbiology
Posters
65 Clinical outcomes of chronic “Prairie Epidemic Strain” Pseudomonas aeruginosa infection in adults with cystic fibrosis
67 CF patients with a declining FEV1 : At risk for acquisition of Burkholderia cepacia complex infection?
R. Somayaji1 , J. Lam1 , M. Surette2 , B. Waddell3 , S. Purighalla3 , C. Sibley1 , H.R. Rabin3 , M.D. Parkins3 . 1 University of Calgary, Calgary, Canada; 2 McMaster University, Department of Medicine, Hamilton, Canada; 3 University of Calgary, Department of Microbiology, Immunology and Infectious Diseases, Calgary, Canada
J. Willekens1 , S. Wanyama2 , M. Thomas2 , E. De Wachter1 , I. De Schutter1 , A. Malfroot1 . 1 Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Department of Pediatrics, Cystic Fibrosis Clinic, Brussels, Belgium; 2 Scientific Institute of Public Health WIV-ISP, Public Health and Surveillance, Brussels, Belgium
Objective: Transmissible Pseudomonas aeruginosa (PA) strains have been described in CF and may be associated with a poorer prognosis. The “Prairie Epidemic Strain” (PES) has been recently identified in up to 30% of patients at prairie-based CF centres, however, its clinical impact remains to be determined. Methods: A cohort study of adults with cystic fibrosis from 1981–2014 was conducted and all PA isolates from clinical visits were prospectively collected. PA strain typing at clinic enrolment, and most recent was conducted by PFGE. Patients were divided into one of four cohorts: no PA, transient PA, unique chronic PA, and chronic PES. Random effects and proportional Cox hazard models were conducted for outcome of death, transplantation and FEV1% decline. Results: 204 patients (54% male) with CF were analysed: 38 no PA, 20 transient PA, 103 unique PA, 43 PES. Baseline FEV1% was lowest in the chronic PES group (p = 0.002). Overall rate of FEV1% decline was −1.19%/year (95% CI: −1.41 to −0.97, p < 0.001); the chronic PES group had the greatest rate of decline at −1.24%/year (p < 0.001). There were a total of 42 deaths and 37 transplants through 1862 and 2050 follow-up years, respectively. The age-adjusted hazard ratio (HR) for death was not different for the PA groups compared to the no PA group. Relative to the no PA group, risk of transplant was increased in those with chronic PES (HR 9.13, CI 1.29−69, p = 0.032) compared to the no PA group. Conclusion: Chronic PES infection is significantly associated with a greater rate of FEV1% decline and risk of lung transplantation but not with increased risk of death compared to no PA infection.
Introduction: Burkholderia cepacia complex (Bcc) infection is considered to be associated with worsening of CF lung disease. Patient to patient spread has been reported, however mechanisms of acquisition of Bcc are not well understood. Method: Data from the Belgian CF Registry (year 2000–2010) were collected. Inclusions: Bcc infected patients with entries on lung function in at least 1 y before and 3 y after Bcc acquisition. For each case, we included 2 controls, matched for age at the index year (year of first Bcc infection), pancreatic status, sex. Cumulative data up to 2 years before index year were compared to values obtained after infection using Rank sum test. Rate of decline in lung function was adjusted for baseline lung function, age, sex. Results: Bcc prevalence in CF is low in Belgium (<3%). 183 patients were included: 61 cases, 122 controls. 59% were F508del homozygous. Mean age in cases was 20.9 y (SD 10.5) vs 20.3 y (SD 10.3) in controls. Among the Bcc, 54% were unspecified, 31% were B. multivorans. Mean FEV1 at index year was 65.2% (SD 24.9) in cases vs 73.1 (SD 26.9) in controls (p = 0.07). FEV1 decline before index year was significantly higher in cases (−1.7%, SD 0.5) compared to controls (−1.0%, SD 0.3) (p = 0.002). FEV1 slopes were comparable in the period after index year (−1.1%, SD 0.5, in cases vs −0.99%, SD 0.4, p = 0.24). Conclusion: Our results suggest that a declining FEV1 precedes acquisition of Bcc and may be a risk factor. After acquisition, lung function decline was comparable in Bcc infected and uninfected patients. These results should be interpreted with caution, since registry data are collected retrospectively and bear a risk of incompleteness or inaccuracy.
66 Incidence of Burkholderia cepacia complex infection in a Cystic Fibrosis Centre in Buenos Aires City, Argentina, from 2004 to 2014 L. Ibarra1 , J. Degrossi2 , L. Jord´a Vargas2 , P. Barrero1 , M. Vazquez1 , A. Teper1 , L. Galanternik1 . 1 Hospital de Ni˜nos Ricardo Gutierrez, Buenos Aires, Argentina; 2 Universidad de Buenos Aires, Facultad de Farmacia y Bioqu´ımica, Buenos Aires, Argentina Burkholderia cepacia complex (Bcc) is recognized as a significant respiratory pathogen in Cystic Fibrosis (CF) patients. The identification at species level among the 18 established Bcc members is an essential tool for epidemiological studies and infection control policies. In the early 2000s the epidemiology of Burkholderia cepacia (Bcc) in Argentina was characterized by the occurrence of a B. contaminans outbreak that took place in major CF centres. This situation was quite different from other countries where B. cenocepacia and B. multivorans have been the most frequent Bcc infecting species in CF patients. Although B. contaminans outbreak was studied, little is known about the evolution of Bcc epidemiology during the last years. The aim of this study was to analyse Bcc infections in CF patients (pt) attending Hospital de Ni˜nos “R. Guti´errez” in 3 different periods between 2004 and 2014. Incidence and distribution of Bcc species have been described. 2004–2005: Incidence 13.5% (22/163 pt). B. contaminans 55.6% (10/18), B. cepacia 16.7% (3/18), B. cenocepacia and B. seminalis 11.1% (2/18), B. multivorans 5.6% (1/18), 4 nonviable strains. 2007–2009: Incidence 6.6% (12/181 pt). B. contaminans 72.7% (8/11), B. cepacia 27.3% (3/11), 1 nonviable strain. 2012–2014: Incidence 5.4% (10/184 pt). B. contaminans 90% (9/10), B. cepacia 10% (1/10). Conclusions: B. contaminans remains the most frequent isolated species among the new cases of infection. Although incidence values have decreased, these results suggest the situation with B. contaminans hasn’t been solved yet. More studies specially focusing on the transmission of these bacteria and the possible sources of infection are needed.
68 Respiratory viral detection in children with cystic fibrosis (CF) I. Tjeˇsi´c-Drinkovi´c1 , S. Ljubin-Sternak1,2 , J. Vraneˇs1,2 , D. Tjeˇsi´c-Drinkovi´c1,3 . 1 University of Zagreb-School of Medicine, Zagreb, Croatia; 2 Dr. A. Stampar ˇ Institute of Public Health, Zagreb, Croatia; 3 University Hospital Centre Zagreb, Department of Pediatrics − CF Unit, Zagreb, Croatia Objectives: The aim of this study was to assess the presence of respiratory viruses in CF patients at routine visits during the two-month period (November-December 2014) and to determine the clinical impact of this finding. Methods: Nasopharyngeal swabs/aspirates from 35 patients were tested using a PCR method (Serplex® RV15 Onestep ACE Detection), detecting 15 respiratory viruses (adenovirus, coronavirus 229E/NL63 and OC43, parainfluenza virus 1, 2, 3 and 4, influenza A and B, respiratory syncytial virus A and B, rhinovirus (RV), metapneumovirus, boccavirus and enterovirus). Results: Patients were 2−24 yrs old (AVR 12 y), 13 chronically colonised with Pseudomonas aeruginosa (PA). Lung function test for 30 subjects showed: 9 normal findings; 11 mild, 7 moderate and 3 severe lung disease. There was no significant difference regarding lung function or PA status between the subgroups of patients positive or negative for viruses. Viruses were detected in 4/35 subjects (2 RV, 1 enterovirus, 1 parainfluenza virus 3) and 3 had concomitant PA isolation (1 chronic colonisation). However, no acute worsening of the respiratory status was found, determined as the presence of fever and upper respiratory symptoms or a recent change in at least two of the following: sputum volume or colour, cough intensity, increased malaise, increased dyspnea, loss of appetite, a decrease of FEV1 >10% (modified Fuchs criteria). Conclusion: In this pilot study chronic PA infection wasn’t associated with a higher rate of viral detection and no immediate negative consequences of virus detection on the respiratory status of CF patients was observed. Further study is needed.