The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis

Abstract

is responsible for chronic infection in many bronchiectasis patients but it is not known whether it is associated with worse clinical outcomes independent of the underlying severity of disease.This study analysed data from 2596 bronchiectasis patients included from 10 different bronchiectasis clinical centres across Europe and Israel, with a 5-year follow-up period. Prevalence of chronic infection and its independent impact on exacerbations, hospitalisations, quality of life and mortality was assessed.The prevalence of chronic infection was 15.0% (n=389). was associated with a higher mortality in a univariate analysis (hazard ratio (HR) 2.02; 95% (confidence interval) CI 1.53-2.66; p<0.0001) but an independent impact on mortality was not found in a multivariate analysis (HR 0.98; 95% CI 0.70-1.36; p=0.89). was independently associated with increased mortality only in patients with frequent exacerbations (two or more per year) (HR 2.03; 95% CI 1.36-3.03; p=0.001). An independent association with worse quality of life of 7.46 points (95% CI 2.93-12.00; p=0.001) was found in a multivariable linear regression. was therefore found to be independently associated with exacerbation frequency, hospital admissions and worse quality of life. Mortality was increased in patients with particularly in the presence of frequent exacerbations.

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

“…Most evidence to date highlights that P. aeruginosa is associated with poorer clinical outcomes (e.g. increased mortality, increased pulmonary exacerbations and increased pulmonary function decline) . Bacterial infection with non‐Pseudomonal bacteria is associated with pulmonary exacerbations (both numbers and severity), therefore the likely impact of attempting to eradicate such infections is less clear.…”

“…Bacterial infection (any) is associated with more frequent and more severe exacerbations . However, the effects are greater with P. aeruginosa infection with increased mortality (OR: 2–2.9), hospital admissions (OR: 2–6.6), exacerbations (one per year), worse lung function and poorer HRQoL (St George's Respiratory Questionnaire (SGRQ): 18.2 points lower) . Direct correlations between bacterial load and inflammation have been demonstrated in adults and children .…”

“…Chronic airway infection is routinely described (particularly with common pathogens including Haemophilus influenzae infection and Pseudomonas aeruginosa infection) and pulmonary exacerbations are frequent . Recent data from the EMBARC Bronchiectasis Registry has demonstrated that ~50% of patients had two or more exacerbations annually and one in three required hospitalization .…”

Emerging therapies in adult and paediatric bronchiectasis

“…Patients not infrequently report symptoms of chest pain, haemoptysis, breathlessness and fatigue, in addition to the complications of chronic productive cough, all of which play a role in their reduced health‐related quality of life (HRQoL) . These symptoms are proportional to airway bacterial load, which results in significant local and systemic inflammation . While it is most frequently observed in patients aged >60 years, it is prevalent in all age groups and cases now exceed the number of patients with cystic fibrosis (CF)‐related bronchiectasis even in paediatric cohorts …”

Bronchiectasis Economics: Spend Money to Save Money

“…Recently, Araújo et al [12] established that P. aeruginosa was independently associated with exacerbation frequency, worse quality of life, and hospital admissions. They also found an increased mortality in the presence of exacerbations.…”