Inhaled antibiotic use is associated with Scedosporium/Lomentospora species isolation in cystic fibrosis

Abstract

Introduction: Prevalence of fungi has been rising in the cystic fibrosis (CF) population.Scedosporium species (spp) is the second most common mold seen in the CF respiratory tract. However, the characteristics associated with Scedosporium isolation and its clinical implications are poorly understood. The goal of this study was to determine clinical factors associated with Scedosporium spp to better understand the mechanisms that may contribute to the emergence of filamentous fungi in CF. Methods:We conducted a retrospective cohort study of subjects followed in the CF Foundation PatientPatients under 6 years of age, history of solid organ transplantation, and insufficient respiratory culture data were excluded. We used a multivariable logistic regression model to determine demographic data and baseline disease characteristics, medications and co-infections associated with Scedosporium spp recovery in CF sputum.Results: Among 19 023 subjects, prevalence of Scedosporium spp was 615 (3.2%).Older age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07, 1.26) and white race (OR 1.69, 95% CI 1.09, 2.63) were the demographic factors associated with Scedosporium spp isolation. Inhaled antibiotic use had a significant association with Scedosporium isolation (OR 2.01, 95% CI 1.61, 2.52). For every additional course of intravenous antibiotics, the odds of Scedosporium isolation increased by 8% (OR 1.08, 95% CI 1.03, 1.14). Conclusions:The association between inhaled antibiotics and Scedosporium informs us that chronic inhaled antibiotics may be playing a role in Scedosporium isolation. Further investigation to better characterize this relationship is necessary. K E Y W O R D S colonization, epidemiology, fungi, infection

Clinical relevance of Scedosporium spp. and Exophiala dermatitidis in patients with cystic fibrosis: A nationwide study

“…isolation in patients with CF. 10 This American retrospective cohort study found that FEV 1 % predicted was not associated with Scedosporium spp. isolation (odds ratio 0.99, 95% CI 0.96–1.04), which is in line with our findings (1.00, 0.99–1.01).…”

“…isolation (odds ratio 0.99, 95% CI 0.96–1.04), which is in line with our findings (1.00, 0.99–1.01). 10 An Australian single centre study did not find a difference in FEV 1 between patients with and without Scedosporium spp. either.…”

“… 7 Scedosporium species have been reported as the second most prevalent filamentous fungus isolated in sputa from 2 to 9% of the patients with CF. 3 , 5 , 9 , 10 Its isolation has been associated with older age, white race, and inhaled antibiotic use. 10 , 11 The genus Scedosporium is an ubiquitous filamentous fungus present mainly in soil, sewage, and polluted waters.…”

“… 3 , 5 , 9 , 10 Its isolation has been associated with older age, white race, and inhaled antibiotic use. 10 , 11 The genus Scedosporium is an ubiquitous filamentous fungus present mainly in soil, sewage, and polluted waters. 12 Several species of Scedosporium have been reported in CF: Scedosporium apiospermum, Scedosporium boydii, Lomentospora prolificans and Scedosporium aurantiacum, Scedosporium ellipsoideum, Scedosporium minutisporum.…”

“…and E. dermatitidis in the lungs only causes harmless colonization of the airways, or also constitutes a clinically relevant risk for patients with CF remains a matter of debate. 10 , 16 , 18 , 19 …”