Risk factors for age at initial Pseudomonas acquisition in the cystic fibrosis epic observational cohort
Margaret Rosenfeld, Julia Emerson, Sharon McNamara, Valeria Thompson, Bonnie W Ramsey, Wayne Morgan, Ronald L Gibson, EPIC Study Group, Terese Evens, Magdalen Gondor, Kathy Hosler, Stasia Lehmann, Peter Hiatt, Charlene Hallmark, Karen Daigle, Cardinal Glennon, Blakeslee Noyes, Vikki Kociela, Henry Dorkin, Ashish George, Erin Leone Thakkallapalli, Jane Solomon, John McNamara, Sandy Landvik, Mary Sachs, Frank Accurso, Meg Anthony, Shelley Mann, Arnold Platzker, Gregory Omlor, Deborah Ouellette, Ibrahim Abdulhamid, Catherine Van Wagnen, Diana Quintero, MaryEllen Freeman, Tami Miller, Hector Gutierrez, Heather Hathorne, Gina Sabbatini, David Orenstein, Caitlin Clarke, Judy Fulton, Elizabeth Hartigan, Sandra Hurban, Allen Dozor, Ingrid Gherson, Madelint Heydendael, Robert Fink, Sandy Bartosik, Philip Black, Karie Robinson, Candy Schmoll, Thomas Lahiri, Sandra Diehl, Joan DeCelie-Germana, Lynn Bonitz, Susan Galvin, Maynard Dyson, Sara Scott, Worth Parker, Dana Dorman, Pamela Hofley, Lisa Moulton, Aaron Chidekel, Sandra Budd, Michael Schechter, Monica Haughton, Eric Hunter, Jeannette Peabody, Helen DeVos, Susan Millard, Hollie Bonnema, Teri Crumb, Barbara Chatfield, Heather Oldroyd, Jane Vroom, Gregory Shay, Julie Lee, Erika Marmolejo, Robert Schoumacher, Barbara Culbreath, Kathleen McKie, Heidi Stapp, Milton S Hershey, Gavin Graff, Lisa Allwein, Diane Kitch, AnneMarie Cairns, Mary Ellen Corrigan, Carrie Milliard, Robert Zanni, Bridget Marra, Karen McCoy, Barbara Butera, Diana Gilmore, Mary Terri Johnson, Veronica Lowell, Patricia Olson, Laura Raterman, David Schaeffer, Rena Sprinkle, Adrienne Prestridge, Jennifer Milam, Catherine Powers, Michael Wall, Aaron Guzik, Ben McCullar, Michael Konstan, Colette Bucur, Ellen Divoky, Kate Hilliard, Jeanne Krenicky, Cheryl Velotta, Michelle Howenstine, Terry Barclay, Lisa Bendy, Margaret Rosenfeld, Judy Gabrysiak, Sharon McNamara, Laurie Varlotta, Marcella Aramburo, Thomas Ferkol, Mary Boyle, Patricia Burks, Jane Quante, Richard Moss, Zoe Davies, Colleen Dunn, Cassie Everson, Ran Anbar, Donna Lindner, Valoree Suttmore, Brian O'Sullivan, Dennis Nielson, Courtney Moreno, Richard Ahrens, Jean Frauenholtz, Tom Santacroce, Mary Teresi, Jamshed Kanga, Brittany Fuller, Tammy Taylor, Tammy Watts, Samya Nasr, Dawn Kruse, Suzanne Miller, Kim Adcock, Linda Bonham, John Colombo, Diane Acquazzino, Shandalle Fertig, Sandra Strizek, Chapel Hill, George Retsch-Bogart, Carol Barlow, Paul Jones, Caroline LaFave, Clement Ren, Nancy Jenks, Mary Platt, Deborah Froh, Mary Alice Blackwell, Patricia Moss, Michael Rock, Linda Makholm, Rebekah Brown, Alice Bray, Daniel Sheehan, Jameelah Ali, Nadine Caci, Margaret Rosenfeld, Julia Emerson, Sharon McNamara, Valeria Thompson, Bonnie W Ramsey, Wayne Morgan, Ronald L Gibson, EPIC Study Group, Terese Evens, Magdalen Gondor, Kathy Hosler, Stasia Lehmann, Peter Hiatt, Charlene Hallmark, Karen Daigle, Cardinal Glennon, Blakeslee Noyes, Vikki Kociela, Henry Dorkin, Ashish George, Erin Leone Thakkallapalli, Jane Solomon, John McNamara, Sandy Landvik, Mary Sachs, Frank Accurso, Meg Anthony, Shelley Mann, Arnold Platzker, Gregory Omlor, Deborah Ouellette, Ibrahim Abdulhamid, Catherine Van Wagnen, Diana Quintero, MaryEllen Freeman, Tami Miller, Hector Gutierrez, Heather Hathorne, Gina Sabbatini, David Orenstein, Caitlin Clarke, Judy Fulton, Elizabeth Hartigan, Sandra Hurban, Allen Dozor, Ingrid Gherson, Madelint Heydendael, Robert Fink, Sandy Bartosik, Philip Black, Karie Robinson, Candy Schmoll, Thomas Lahiri, Sandra Diehl, Joan DeCelie-Germana, Lynn Bonitz, Susan Galvin, Maynard Dyson, Sara Scott, Worth Parker, Dana Dorman, Pamela Hofley, Lisa Moulton, Aaron Chidekel, Sandra Budd, Michael Schechter, Monica Haughton, Eric Hunter, Jeannette Peabody, Helen DeVos, Susan Millard, Hollie Bonnema, Teri Crumb, Barbara Chatfield, Heather Oldroyd, Jane Vroom, Gregory Shay, Julie Lee, Erika Marmolejo, Robert Schoumacher, Barbara Culbreath, Kathleen McKie, Heidi Stapp, Milton S Hershey, Gavin Graff, Lisa Allwein, Diane Kitch, AnneMarie Cairns, Mary Ellen Corrigan, Carrie Milliard, Robert Zanni, Bridget Marra, Karen McCoy, Barbara Butera, Diana Gilmore, Mary Terri Johnson, Veronica Lowell, Patricia Olson, Laura Raterman, David Schaeffer, Rena Sprinkle, Adrienne Prestridge, Jennifer Milam, Catherine Powers, Michael Wall, Aaron Guzik, Ben McCullar, Michael Konstan, Colette Bucur, Ellen Divoky, Kate Hilliard, Jeanne Krenicky, Cheryl Velotta, Michelle Howenstine, Terry Barclay, Lisa Bendy, Margaret Rosenfeld, Judy Gabrysiak, Sharon McNamara, Laurie Varlotta, Marcella Aramburo, Thomas Ferkol, Mary Boyle, Patricia Burks, Jane Quante, Richard Moss, Zoe Davies, Colleen Dunn, Cassie Everson, Ran Anbar, Donna Lindner, Valoree Suttmore, Brian O'Sullivan, Dennis Nielson, Courtney Moreno, Richard Ahrens, Jean Frauenholtz, Tom Santacroce, Mary Teresi, Jamshed Kanga, Brittany Fuller, Tammy Taylor, Tammy Watts, Samya Nasr, Dawn Kruse, Suzanne Miller, Kim Adcock, Linda Bonham, John Colombo, Diane Acquazzino, Shandalle Fertig, Sandra Strizek, Chapel Hill, George Retsch-Bogart, Carol Barlow, Paul Jones, Caroline LaFave, Clement Ren, Nancy Jenks, Mary Platt, Deborah Froh, Mary Alice Blackwell, Patricia Moss, Michael Rock, Linda Makholm, Rebekah Brown, Alice Bray, Daniel Sheehan, Jameelah Ali, Nadine Caci
Abstract
Background: Risk factors for initial Pseudomonas aeruginosa (Pa) acquisition, particularly environmental exposures, are poorly understood. We aimed to identify such risk factors in order to inform prevention strategies and identify high-risk populations.
Methods: The study cohort included all participants in the U.S. EPIC Observational Study who had no prior Pa-positive respiratory cultures (N=889). Cox proportional hazard models were used to test the effects of factors on age at first Pa-positive respiratory culture.
Results: Cystic fibrosis (CF) genotype functional class had an important effect on age at initial Pa acquisition (hazard ratio (HR) comparing minimal to residual CFTR function 2.87 (95% CI 1.88, 4.39)). None of the modifiable risk factors evaluated, including cigarette smoke, hot tub use, breastfeeding, or daycare, was associated with age at Pa acquisition. Similarly, newborn screening was not associated with age at Pa acquisition (HR 0.85, 95% CI 0.66, 1.09). Key associations were validated in a CF Foundation National Patient Registry replication cohort.
Conclusions: Given the ubiquitous presence of Pa in the environment, it may be that many imposed lifestyle changes will have less impact on age at initial Pa acquisition than genetic determinants.
Trial registration: ClinicalTrials.gov NCT00676169.
Copyright © 2012 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.
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Source: PubMed