Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Definition of Terminology and Outcomes
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Population
3.2. Clinical Characteristics Related to Bronchiectasis
3.3. Clinical Outcomes Based on Pseudomonas Colonization
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | Total n = 445 | Pseudomonas Group n = 89 | Non-Pseudomonas Group n = 356 | p-Value |
---|---|---|---|---|
Age | 64.4 ± 9.4 | 63.5 ± 9.8 | 64.6 ± 9.3 | 0.358 |
Sex, Female, n (%) | 289 (64.9) | 56 (62.9) | 233 (65.5) | 0.655 |
BMI | 22.9 ± 3.5 | 23.0 ± 3.5 | 23.0 ± 3.5 | 0.120 |
Median duration between BE diagnosed to enrollment, (IQR) | 3 (1–6) | 3 (1–6) | 3 (1–6) | 0.011 |
Smoking history, n (%) | 0.469 | |||
Current smoker | 14 (3.2) | 1 (1.1) | 13 (3.7) | |
Former smoker | 111 (25.1) | 23 (25.8) | 88 (24.9) | |
Never smoker | 318 (71.8) | 65 (73.0) | 253 (71.5) | |
Pack-years | 3.2 (1.3) | 2.9 (1.2) | 3.3 (1.3) | 0.233 |
Past medical history, n (%) | ||||
COPD | 152 (34.4) | 39 (43.8) | 113 (32.0) | 0.036 |
Asthma | 102 (23.0) | 14 (15.7) | 88 (24.9) | 0.069 |
History of TB | 148 (36.1) | 35 (39.3) | 123 (35.2) | 0.474 |
Rhinosinusitis | 28 (6.3) | 9 (10.1) | 19 (5.4) | 0.100 |
Cardiovascular disease | 131 (29.4) | 24 (27.0) | 107 (30.1) | 0.567 |
Pulmonary hypertension | 15 (3.5) | 1 (1.2) | 14 (4.1) | 0.323 |
Stroke | 11 (2.6) | 1 (1.2) | 10 (2.9) | 0.700 |
Diabetes mellitus | 58 (13.2) | 5 (6.8) | 52 (14.7) | 0.049 |
Osteoporosis | 48 (10.8)6 | 6 (6.7) | 42 (11.8) | 0.167 |
Chronic renal failure | 9 (2.1) | 0 (0.0) | 9 (2.6) | 0.131 |
Cancer, total | 40 (9.0) | 4 (4.5) | 36 (10.2) | 0.095 |
Depression | 19 (4.3) | 2 (2.3) | 17 (4.8) | 0.390 |
Anxiety | 13 (2.9) | 2 (2.3) | 11 (3.1) | 0.999 |
Radiologic severity of the bronchiectasis | ||||
Total number of involved lobes, mean (SD) | 2.4 (1.6) | 2.7 (1.5) | 2.3 (1.6) | 0.021 |
Patients with relevant lobe involvement, n (%) | ||||
RUL | 175 (39.3) | 43 (48.3) | 132 (37.1) | 0.052 |
RML | 257 (57.8) | 53 (59.6) | 204 (57.3) | 0.701 |
RLL | 248 (55.7) | 57 (64.0) | 191 (53.7) | 0.077 |
LUL | 159 (35.7) | 33 (37.1) | 126 (35.4) | 0.767 |
Lingula | 224 (50.3) | 57 (64.0) | 167 (46.9) | 0.004 |
LLL | 319 (71.7) | 74 (83.2) | 245 (68.8) | 0.007 |
Cystic bronchiectasis, n (%) | 200 (44.9) | 53 (59.6) | 147 (41.3) | 0.002 |
Laboratory findings | ||||
WBC (103/uL) | 9.6 (3.9) (n = 65) | 10.3 (3.2) (n = 14) | 9.4 (4.0) (n = 51) | 0.437 |
Neutrophil (%) | 70.5 (10.8) (n = 68) | 73.3 (7.2) (n = 16) | 69.7 (11.6) (n = 52) | 0.146 |
Lymphocyte (%) | 20.8 (9.4) (n = 68) | 18.4 (6.4) (n = 16) | 21.6 (10.1) (n = 52) | 0.141 |
Monocyte (%) | 6.3 (2.1) (n = 68) | 6.6 (1.3) (n = 16) | 6.2 (2.3) (n = 52) | 0.454 |
Eosinophil (%) | 1.5 (1.2) (n = 68) | 1.0 (1.1) (n = 16) | 1.6(1.3) (n = 52) | 0.117 |
Hemoglobin (g/dL) | 12.6 (1.5) (n = 65) | 12.9 (2.0) (n = 14) | 12.5(1.4) (n = 51) | 0.456 |
Platelet (103/uL) | 283.1(83.0) (n = 65) | 303.1(106.3) (n = 14) | 277.6(75.8) (n = 51) | 0.314 |
Total bilirubin (mg/dL) | 0.50 (0.03) (n = 70) | 0.50 (0.05) (n = 16) | 0.5 (0.04) (n = 54) | 0.946 |
Serum albumin (g/dL) | 4.0(0.5) (n = 46) | 4.1 (0.5) (n = 10) | 4.0 (0.5) (n = 36) | 0.665 |
BUN (mg/dL) | 15.2 (5.8) (n = 70) | 14.4 (3.8) (n = 16) | 15.4 (6.3) (n = 54) | 0.532 |
Creatinine (mt/dL) | 0.75 (0.24) (n = 70) | 0.80 (0.19) (n = 16) | 0.73(0.25) (n = 54) | 0.318 |
Past medication history | ||||
Long term macrolide use (≥1 month) | 20 (6.7) | 8 (11.3) | 12 (5.3) | 0.081 |
Inhaled corticosteroid use * | 78 (17.5) | 11 (12.4) | 67 (18.8) | 0.152 |
Long term use of bronchodilators † | 218 (66.1) | 51 (71.8) | 167 (64.5) | 0.246 |
Variables | Patients Obtained Microbiologic Samples from the Airway in Medically Stable Status n = 341 |
---|---|
Patients from whose respiratory secretion isolated microorganism, n (%) * | 159 (46.6) |
Microorganism, n (%) # | |
Pseudomonas aeruginosa | 92/159 (57.9) |
Streptococcus viridans | 23/159 (14.5) |
Klebsiella pneumonia | 10/159 (6.3) |
Staphylococcus aureus | 10/159 (6.3) |
Hemophilus influenzae | 7/159 (4.4) |
Escherichia coli | 7/159 (4.4) |
Enterobacter cloacae | 4/159 (2.5) |
Streptococcus pneumonia | 3/159 (1.9) |
Moraxella catarrhalis | 2/159 (1.2) |
Acinetobacter baumannii | 1/159 (0.6) |
Others § | 2/159 (1.2) |
Source of microbiology. n (%) † | |
Sputum | 269 (95.7%) |
Induced sputum | 10 (2.6%) |
Total n = 445 | Pseudomonas Group n = 89 | Non-Pseudomonas Group n = 356 | p-Value | |
---|---|---|---|---|
Lung function, mean (SD) | ||||
Pre BD FEV1, absolute [L] | 1.59 (0.58) | 1.35 (0.49) | 1.66 (0.59) | <0.001 |
Pre BD FEV1, % predicted | 64.2 (19.0) | 56.5 (18.1) | 66.0 (18.8) | <0.001 |
Pre BD FVC, absolute [L] | 2.51 (0.76) | 2.24 (0.72) | 2.57 (0.75) | <0.001 |
Pre BD FVC, % predicted | 73.2 (15.7) | 65.7 (15.5) | 74.8 (15.3) | <0.001 |
Post BD FEV1, absolute [L] | 1.71 (0.58) | 1.50 (0.57) | 1.76 (0.58) | 0.001 |
Post BD FEV1, % predicted | 66.6 (18.8) | 58.5 (17.6) | 68.5 (18.6) | <0.001 |
Post BD FVC, absolute [L] | 2.55 (0.75) | 2.26 (0.72) | 2.61 (0.75) | <0.001 |
Post BD FVC, % predicted | 73.9 (15.4) | 66.3 (15.0) | 75.6 (15.0) | <0.001 |
Respiratory symptom | ||||
mMRC, mean (SD) | 1.00 (0.84) | 1.12 (0.99) | 0.07 (0.80) | 0.165 |
Patient with each mMRC, n (%) | 0.175 | |||
mMRC grade ≥ 2 | 84 (19.0) | 22 (24.7) | 62 (17.5) | 0.121 |
mMRC grade ≥ 3 | 28 (6.3) | 9 (10.1) | 19 (5.4) | 0.100 |
mMRC grade 4 | 5 (1.1) | 3 (3.4) | 2 (0.56) | 0.058 |
Sputum color | 0.242 | |||
Mucus | 283 (65.2) | 59 (66.3) | 224 (64.9) | |
Mucopurulent | 112 (25.8) | 18 (20.2) | 94 (27.3) | |
Purulent | 34 (7.8) | 10 (11.2) | 24 (7.0) | |
Very Purulent | 5 (1.2) | 2 (2.3) | 3 (0.9) | |
Sputum volume, cc/day mean (SD) | 26.2 (25.0) | 21.0 (22.3) | 29.2 (26.1) | 0.145 |
h/o major hemoptysis, n (%) | 29 (10.3) | 9 (14.1) | 20 (9.1) | 0.253 |
Acute exacerbation history | ||||
Presence of AE, n (%) | 209 (54.3) | 46 (54.8) | 163 (54.2) | 0.921 |
Number of AE, mean (SD) | 1.5 (2.3) | 1.6 (2.2) | 1.5 (2.4) | 0.794 |
More than 2 annual exacerbations, n (%) | 129 (33.5) | 30 (35.7) | 99 (32.9) | 0.628 |
Requiring antibiotics, mean (SD) | 1.7 (2.1) | 2.3 (2.5) | 1.5 (2.0) | 0.096 |
Requiring ER visit, n (%) | 31 (7.0) | 9 (10.1) | 22 (6.2) | 0.198 |
Requiring hospital admission, n (%) | 81 (18.3) | 18 (20.2) | 63 (17.8) | 0.596 |
Hospital admission due to bronchiectasis, n (%) | 118 (26.6) | 30 (33.7) | 88 (24.9) | 0.091 |
BHQ score, mean (SD) | 63.7 (10.7) | 61.3 (11.0) | 64.3 (10.6) | 0.018 |
FACED score, mean (SD) | 2.1 (1.7) | 3.1 (1.6) | 1.9 (1.6) | <0.001 |
BSI score, mean (SD) | 7.4 (3.9) | 10.5 (3.4) | 6.6 (3.6) | <0.001 |
Total n = 445 | Pseudomonas Group n = 89 | Non-Pseudomonas Group n = 356 | p-Value | |
---|---|---|---|---|
Risk of exacerbation, crude odds ratio (CI) | 1.78 (1.07–2.97) | Ref | 0.027 | |
Risk of exacerbation, adjusted odds ratio (CI) * | 1.66 (0.98–2.82) | Ref | 0.058 | |
Risk of exacerbation of ED visit, crude odds ratio (CI) | 1.95 (0.58–6.57) | Ref | 0.283 | |
Risk of exacerbation of ED visit, adjusted odds ratio (CI) * | 1.64 (0.46–5.83) | Ref | 0.441 | |
Risk of admission due to bronchiectasis, crude odds ratio (CI) | 2.29 (1.18–4.43) | Ref | 0.014 | |
Risk of admission due to bronchiectasis, adjusted adds ratio (CI) * | 2.19 (1.08–4.42) | Ref | 0.028 | |
Risk of hemoptysis, crude odds ratio (CI) | 1.48 (0.82–2.64) | Ref | 0.191 | |
Risk of hemoptysis, adjusted adds ratio (CI) * | 1.54 (0.85–2.81) | Ref | 0.153 | |
Risk of antibiotics treatment, crude odds ratio (CI) | 3.08 (1.22–7.80) | Ref | 0.018 | |
Risk of antibiotics treatment, adjusted adds ratio (CI) * | 3.04 (1.17–7.91) | Ref | 0.022 | |
BHQ score * | 66.0 (11.7) (n = 236) | 60.5 (11.7) (n = 54) | 67.7 (11.2) (n = 182) | <0.001 |
FACED score * | 2.1 (1.6) (n = 37) | 3.0 (2.2) (n = 8) | 1.9 (1.4) (n = 29) | 0.080 |
BSI score * | 7.6 (4.3) (n = 37) | 8.8 (4.9) (n = 8) | 7.2 (4.1) (n = 29) | 0.345 |
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Song, J.; Sin, S.; Kang, H.-R.; Oh, Y.-M.; Jeong, I., on behalf of the KMBARC. Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry. J. Clin. Med. 2024, 13, 5011. https://doi.org/10.3390/jcm13175011
Song J, Sin S, Kang H-R, Oh Y-M, Jeong I on behalf of the KMBARC. Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry. Journal of Clinical Medicine. 2024; 13(17):5011. https://doi.org/10.3390/jcm13175011
Chicago/Turabian StyleSong, Jinhwa, Sooim Sin, Hye-Rin Kang, Yeon-Mok Oh, and Ina Jeong on behalf of the KMBARC. 2024. "Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry" Journal of Clinical Medicine 13, no. 17: 5011. https://doi.org/10.3390/jcm13175011