Pseudomonas aeruginosa associated with severity of non-cystic fibrosis bronchiectasis measured by the modified bronchiectasis severity score (BSI) and the FACED: The US bronchiectasis and NTM Research Registry (BRR) study - 23/02/21

Doi : 10.1016/j.rmed.2020.106285

Radmila Choate ^a,^b,^⁎ , Timothy R. Aksamit ^c, David Mannino ^d, Doreen Addrizzo-Harris ^e, Alan Barker ^f, Ashwin Basavaraj ^e, Charles L. Daley ^g, M. Leigh Anne Daniels ^h, Edward Eden ⁱ, Angela DiMango ^j, Kevin Fennelly ^k, David E. Griffith ^l, Margaret M. Johnson ^m, Michael R. Knowles ^h, Pamela J. McShane ⁿ, Mark L. Metersky ^o, Peadar G. Noone ^h, Anne E. O'Donnell ^p, Kenneth N. Olivier ^k, Matthias A. Salathe ^q, Andreas Schmid ^q, Byron Thomashow ^j, Gregory Tino ^r, Kevin L. Winthrop ^f,^s, Glenda Stone ^t
^a University of Kentucky, College of Public Health, Lexington, KY, USA
^b Research, COPD Foundation, USA
^c Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
^d University of Kentucky, College of Medicine, Lexington, KY, USA
^e New York University School of Medicine, New York, NY, USA
^f Department of Pulmonology, OHSU School of Medicine, Portland, OR, USA
^g Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
^h University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
ⁱ Icahn School of Medicine, Mt. Sinai West and Mt. Sinai St Luke's Hospitals, Mt. Sinai, NY, USA
^j Columbia College of Physicians and Surgeons, Center for Chest Disease, New York, NY, USA
^k National Heart Lung and Blood Institute, NIH, Bethesda, MD, USA
^l University of Texas at Tyler, Tyler, TX, USA
^m Mayo Clinic Florida, Pulmonary and Critical Care, Jacksonville, FL, USA
ⁿ University of Texas Health Science Center at Tyler, Tyler, TX, USA
^o Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
^p Georgetown University Medical Center, Washington, DC, USA
^q University of Kansas Medical Center, Kansas City, KS, USA
^r University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
^s Department of Infectious Disease, OHSU School of Medicine, Portland, OR, USA
^t Grifols, Inc, USA

^∗Corresponding author. University of Kentucky, College of Public Health, Lexington, KY, USA.University of KentuckyCollege of Public HealthLexingtonKYUSA

Abstract

Rationale

Non-cystic fibrosis bronchiectasis (NCFB) is characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Pseudomonas aeruginosa (PA) is one of the most frequently isolated pathogens in patients with NCFB. The purpose of this study was to evaluate the association between presence of PA and disease severity in patients within the US Bronchiectasis and Nontuberculous mycobacteria (NTM) Research Registry (BRR).

Methods

Baseline US BRR data from adult patients with NCFB collected between 2008 and 2018 was used for this study. The presence of PA was defined as one or more positive PA cultures within two years prior to enrollment. Modified Bronchiectasis Severity Index (m-BSI) and modified FACED (m-FACED) were computed to evaluate severity of bronchiectasis. Unadjusted and multivariable multinomial regression models were used to assess the association between presence of PA and severity of bronchiectasis.

Results

Average age of the study participants (n = 1831) was 63.7 years (SD = 14.1), 91.5% white, and 78.8% female. Presence of PA was identified in 25.4% of the patients. Patients with presence of PA had significantly lower mean pre-bronchodilator FEV1% predicted compared to those without PA (62.8% vs. 73.7%, p < .0001). In multivariate analyses, patients with presence of PA had significantly greater odds for having high (OR_adj = 6.15 (95%CI:3.98–9.50) and intermediate (OR_adj = 2.06 (95%CI:1.37–3.09) severity vs. low severity on m-BSI.

Conclusion

The presence of PA is common in patients with NCFB within the Bronchiectasis and NTM Research Registry. Severity of bronchiectasis is significantly greater in patients with PA which emphasizes high burden of the disease.

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Highlights

•	Prevalence of Pseudomonas aeruginosa is high in patients within the US BRR.
•	Modified bronchiectasis severity indices were used to estimate disease burden.
•	Severity of bronchiectasis is significantly greater in patients with Pseudomonas.
•	Higher disease severity remained after excluding Pseudomonas variable from indices.

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Keywords : Non-cystic fibrosis bronchiectasis, Pseudomonas aeruginosa, Bronchiectasis severity, Severity scores, Registry

Abbreviations : NCFB, NTM, BRR, NTMLD, PA, BSI, FEV1, FVC

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Pseudomonas aeruginosa associated with severity of non-cystic fibrosis bronchiectasis measured by the modified bronchiectasis severity score (BSI) and the FACED: The US bronchiectasis and NTM Research Registry (BRR) study - 23/02/21

Abstract

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Methods

Results

Conclusion

Highlights

Plan

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