Abstract

Introduction

Stenotrophomonas maltophilia is a bacteria whose role in patients with cystic fibrosis (CF) bronchiectasis has been previously studied; little is known about its role in non-CF bronchiectasis.

Materials and methods

Aim of our study is to investigate the risk factors for S. maltophilia acquisition and its clinical impact on bronchiectasis patients. A retrospective observational cohort study enrolling patients attending the Bronchiectasis Clinic at the Royal Infirmary of Edinburgh, Scotland, UK. A total of 167 bronchiectasis patients undergoing intravenous (IV) antibiotic therapy were selected and divided according to single or chronic S. maltophilia isolation in sputum. The risk factors and prognostic impact were studied.

Results

Single isolation was independently associated with lower baseline % predicted forced expiratory volume in 1 s [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.970–1.044; P = 0.025] and with less radiological involvement (OR 0.379; 95% CI 0.175–0.819; P = 0.01). Chronic isolation was associated with the number of IV antibiotic courses in the year before and after the first isolation (OR 1.2; 95% CI 1.053–1.398; P = 0.007) and with the absence of Pseudomonas aeruginosa colonization (OR 0.207; 95% CI 0.056–0.764; P = 0.02). In the chronic isolation group, there were more exacerbations and more need of IV antibiotics in the year after the first isolation.

Conclusions

Poor lung function is the main independent risk factor for single isolation of S. maltophilia. For chronic colonization, the main independent risk factor is the number of IV antibiotic courses and the absence of P. aeruginosa chronic colonization. Only when chronically present, S. maltophilia had a clinical impact with more exacerbations.

中文翻译：

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嗜麦芽窄食单胞菌分离在非 CF 支气管扩张患者中的作用

摘要

介绍

嗜麦芽窄食单胞菌是一种细菌，其在囊性纤维化 (CF) 支气管扩张患者中的作用先前已被研究过；对其在非 CF 支气管扩张中的作用知之甚少。

材料和方法

我们研究的目的是调查嗜麦芽窄食单胞菌获得的危险因素及其对支气管扩张患者的临床影响。一项回顾性观察队列研究，招募了在英国苏格兰爱丁堡皇家医院的支气管扩张诊所就诊的患者。总共选择了 167 名接受静脉 (IV) 抗生素治疗的支气管扩张患者，并根据痰中分离出单一或慢性嗜麦芽窄食单胞菌进行了划分。研究了危险因素和预后影响。

结果

单次隔离与较低的基线 1 秒内预测用力呼气量百分比独立相关 [优势比 (OR) 0.98；95% 置信区间 (CI) 0.970–1.044；P  = 0.025] 且放射学受累较少（OR 0.379；95% CI 0.175–0.819；P  = 0.01）。慢性隔离与第一次隔离前后一年中静脉注射抗生素的次数有关（OR 1.2；95% CI 1.053–1.398；P  = 0.007）和没有铜绿假单胞菌定植（OR 0.207；95% CI 0.056–0.764；P  = 0.02）。在慢性隔离组中，第一次隔离后的一年内出现更多恶化和更多需要静脉注射抗生素。

结论

肺功能差是单次分离嗜麦芽窄食单胞菌的主要独立危险因素。对于慢性定植，主要的独立危险因素是静脉注射抗生素疗程的数量和铜绿假单胞菌没有慢性定植。仅当长期存在时，嗜麦芽窄食单胞菌具有更多恶化的临床影响。