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Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort

BACKGROUND: Tracheobronchial colonization by Pseudomonas aeruginosa (PA) has been shown to negatively impact outcomes in cystic fibrosis and bronchiectasis. There is uncertainty whether the same association is prevalent in chronic obstructive pulmonary disease (COPD), especially in the outpatient se...

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Autores principales: Jacobs, David M, Ochs-Balcom, Heather M, Noyes, Katia, Zhao, Jiwei, Leung, Wai Yin, Pu, Chan Yeu, Murphy, Timothy F, Sethi, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979313/
https://www.ncbi.nlm.nih.gov/pubmed/31993457
http://dx.doi.org/10.1093/ofid/ofz546
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author Jacobs, David M
Ochs-Balcom, Heather M
Noyes, Katia
Zhao, Jiwei
Leung, Wai Yin
Pu, Chan Yeu
Murphy, Timothy F
Sethi, Sanjay
author_facet Jacobs, David M
Ochs-Balcom, Heather M
Noyes, Katia
Zhao, Jiwei
Leung, Wai Yin
Pu, Chan Yeu
Murphy, Timothy F
Sethi, Sanjay
author_sort Jacobs, David M
collection PubMed
description BACKGROUND: Tracheobronchial colonization by Pseudomonas aeruginosa (PA) has been shown to negatively impact outcomes in cystic fibrosis and bronchiectasis. There is uncertainty whether the same association is prevalent in chronic obstructive pulmonary disease (COPD), especially in the outpatient setting. Our objective was to determine (1) whether PA isolation is associated with mortality and (2) changes in exacerbation and hospitalization rates within a longitudinal cohort of COPD outpatients. METHODS: Pseudomonas aeruginosa colonization was ascertained in monthly sputum cultures in a prospective cohort of COPD patients from 1994 to 2014. All-cause mortality was compared between patients who were colonized during their follow-up period (PA(+)) and those who remained free of colonization (PA(−)); Cox proportional hazards models were used. Exacerbation and hospitalization rates were evaluated by 2-rate χ (2) and segmented regression analysis for 12 months before and 24 months after PA isolation. RESULTS: Pseudomonas aeruginosa was isolated from sputum in 73 of 181 (40%) patients. Increased mortality was seen with PA isolation: 56 of 73 (77%) PA(+) patients died compared with 73 of 108 (68%) PA(−) patients (P = .004). In adjusted models, PA(+) patients had a 47% higher risk of mortality (adjusted hazard ratio = 1.47; 95% confidence interval, 1.03–2.11; P = .04). Exacerbation rates were higher for the PA(+) group during preisolation (15.4 vs 9.0 per 100 person-months, P < .001) and postisolation periods (15.7 vs 7.5, P < .001). Hospitalization rates were higher during the postisolation period among PA(+) patients (6.25 vs 2.44, P < .001). CONCLUSIONS: Tracheobronchial colonization by PA in COPD outpatients was associated with higher morbidity and mortality. This suggests that PA likely contributes to adverse clinical outcomes rather than just a marker of worsening disease.
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spelling pubmed-69793132020-01-28 Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort Jacobs, David M Ochs-Balcom, Heather M Noyes, Katia Zhao, Jiwei Leung, Wai Yin Pu, Chan Yeu Murphy, Timothy F Sethi, Sanjay Open Forum Infect Dis Major Articles BACKGROUND: Tracheobronchial colonization by Pseudomonas aeruginosa (PA) has been shown to negatively impact outcomes in cystic fibrosis and bronchiectasis. There is uncertainty whether the same association is prevalent in chronic obstructive pulmonary disease (COPD), especially in the outpatient setting. Our objective was to determine (1) whether PA isolation is associated with mortality and (2) changes in exacerbation and hospitalization rates within a longitudinal cohort of COPD outpatients. METHODS: Pseudomonas aeruginosa colonization was ascertained in monthly sputum cultures in a prospective cohort of COPD patients from 1994 to 2014. All-cause mortality was compared between patients who were colonized during their follow-up period (PA(+)) and those who remained free of colonization (PA(−)); Cox proportional hazards models were used. Exacerbation and hospitalization rates were evaluated by 2-rate χ (2) and segmented regression analysis for 12 months before and 24 months after PA isolation. RESULTS: Pseudomonas aeruginosa was isolated from sputum in 73 of 181 (40%) patients. Increased mortality was seen with PA isolation: 56 of 73 (77%) PA(+) patients died compared with 73 of 108 (68%) PA(−) patients (P = .004). In adjusted models, PA(+) patients had a 47% higher risk of mortality (adjusted hazard ratio = 1.47; 95% confidence interval, 1.03–2.11; P = .04). Exacerbation rates were higher for the PA(+) group during preisolation (15.4 vs 9.0 per 100 person-months, P < .001) and postisolation periods (15.7 vs 7.5, P < .001). Hospitalization rates were higher during the postisolation period among PA(+) patients (6.25 vs 2.44, P < .001). CONCLUSIONS: Tracheobronchial colonization by PA in COPD outpatients was associated with higher morbidity and mortality. This suggests that PA likely contributes to adverse clinical outcomes rather than just a marker of worsening disease. Oxford University Press 2020-01-04 /pmc/articles/PMC6979313/ /pubmed/31993457 http://dx.doi.org/10.1093/ofid/ofz546 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Articles
Jacobs, David M
Ochs-Balcom, Heather M
Noyes, Katia
Zhao, Jiwei
Leung, Wai Yin
Pu, Chan Yeu
Murphy, Timothy F
Sethi, Sanjay
Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title_full Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title_fullStr Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title_full_unstemmed Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title_short Impact of Pseudomonas aeruginosa Isolation on Mortality and Outcomes in an Outpatient Chronic Obstructive Pulmonary Disease Cohort
title_sort impact of pseudomonas aeruginosa isolation on mortality and outcomes in an outpatient chronic obstructive pulmonary disease cohort
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979313/
https://www.ncbi.nlm.nih.gov/pubmed/31993457
http://dx.doi.org/10.1093/ofid/ofz546
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