慢性铜绿假单胞菌感染在囊性纤维化患者中的变化率：一项基于人群的队列研究。
Changing Rates of Chronic Pseudomonas aeruginosa Infections in Cystic Fibrosis: A Population-Based Cohort Study.
机构信息
Department of Medicine, University of Washington, Seattle.
Department of Medicine, University of Calgary, Alberta, Canada.
出版信息
Clin Infect Dis. 2018 Sep 14;67(7):1089-1095. doi: 10.1093/cid/ciy215.
BACKGROUND
Chronic Pseudomonas aeruginosa lung infection is associated with significant morbidity and mortality in cystic fibrosis (CF). It is not known whether recent advances in care have affected the rates of chronic infection. We aimed to determine if the rates of developing new chronic P. aeruginosa infection among adolescents and adults with CF significantly changed over time.
METHODS
The cohort consisted of individuals with CF followed in the Cystic Fibrosis Foundation Patient Registry aged ≥13 years without chronic P. aeruginosa at baseline. Multivariable regression models accounting for within-patient correlation were used to assess the change in rate of developing chronic P. aeruginosa infection between 2003 and 2012.
RESULTS
A total of 15504 individuals were followed for a median of 5 (interquartile range, 2-9) years. The annual rates of developing new chronic P. aeruginosa decreased from 14.3% in 2003 to 6.4% in 2012. After adjusting for potential confounders, relative risk (RR) of developing chronic P. aeruginosa infection decreased significantly over time compared to 2003 (P value test of trend < .001). Compared with 2003, the RR of developing chronic P. aeruginosa infection in 2012 was 0.33 (95% confidence interval, 0.30-0.37). No significant increases in risk of chronic infections with other major CF bacterial pathogens relative to 2003 were identified.
CONCLUSIONS
Among individuals with CF, a significant decrease in the risk and rates of developing chronic P. aeruginosa infection between 2003 and 2012 was observed. Whether this decline results in changes in clinical outcomes warrants further exploration.
背景
慢性铜绿假单胞菌肺部感染与囊性纤维化（CF）患者的高发病率和高死亡率密切相关。目前尚不清楚最近的治疗进展是否影响了慢性感染的发生率。我们旨在确定 CF 青少年和成年患者中新发慢性铜绿假单胞菌感染的发生率是否随时间显著变化。
方法
该队列由在囊性纤维化基金会患者登记处接受随访的年龄≥13 岁且基线时无慢性铜绿假单胞菌感染的 CF 患者组成。使用考虑到患者内相关性的多变量回归模型来评估 2003 年至 2012 年期间慢性铜绿假单胞菌感染发展率的变化。
结果
共有 15504 名患者接受了中位 5（四分位距，2-9）年的随访。新发慢性铜绿假单胞菌感染的年发生率从 2003 年的 14.3%降至 2012 年的 6.4%。在调整了潜在混杂因素后，与 2003 年相比，慢性铜绿假单胞菌感染的发病相对风险（RR）随时间显著降低（趋势检验 P 值<0.001）。与 2003 年相比，2012 年发生慢性铜绿假单胞菌感染的 RR 为 0.33（95%置信区间，0.30-0.37）。与 2003 年相比，未发现其他主要 CF 细菌病原体引起的慢性感染风险显著增加。
结论
在 CF 患者中，2003 年至 2012 年间慢性铜绿假单胞菌感染的风险和发生率显著下降。这种下降是否会导致临床结局的变化，尚需进一步探讨。
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