Abstract:
RATIONALE:Chronic infection with Burkholderia cepacia complex bacteria in cystic fibrosis is associated with accelerated decline in pulmonary function and increased mortality. Clinical implications of the recently characterized genomovar VI, B. dolosa, are unknown. OBJECTIVES:Characterization of impact of B. dolosa on pulmonary function and mortality in cystic fibrosis. METHODS:We compared patients chronically infected with B. dolosa (n = 31) with unmatched patients with B. multivorans (n = 24) and with age- and sex-matched control subjects without Burkholderia species (n = 58). We analyzed rates of pulmonary function decline (% predicted FEV(1)) using a random effects model assuming segmented linear trends. All available FEV(1) measurements from 5 yr (median, 4.8) before until 2.5 yr (median, 1.5) after the first positive culture for Burkholderia (reference date) were analyzed. Survival was compared using the Kaplan-Meier method and proportional hazards model. MEASUREMENTS AND MAIN RESULTS:Baseline FEV(1) and rate of decline were similar in the cohorts. Decline in FEV(1) after the reference date accelerated in patients with B. dolosa (-2.3 percentage points/yr pre vs. -7.1 post, p = 0.002), but was unchanged in the B. multivorans and control patients (-2.3 vs. -0.8 post, p = 0.38, and -2.1 pre vs. -0.5 post, p = 0.20, respectively). The probability of dying within 18 mo of the reference date was 13, 7, and 3% for B. dolosa, B. multivorans, and control patients, respectively (B. dolosa vs. control hazard ratio, 10.8; 95% confidence interval, 1.3-92.8; p = 0.03). CONCLUSIONS:B. dolosa chronic infection in cystic fibrosis is associated with accelerated loss of lung function and decreased survival.
journal_name
Am J Respir Crit Care Medauthors
Kalish LA,Waltz DA,Dovey M,Potter-Bynoe G,McAdam AJ,Lipuma JJ,Gerard C,Goldmann Ddoi
10.1164/rccm.200503-344OCkeywords:
subject
Has Abstractpub_date
2006-02-15 00:00:00pages
421-5issue
4eissn
1073-449Xissn
1535-4970pii
200503-344OCjournal_volume
173pub_type
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