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Original Research: CYSTIC FIBROSIS |

Incidence and Risk Factors for Pulmonary Exacerbation Treatment Failures in Patients With Cystic Fibrosis Chronically Infected With Pseudomonas aeruginosaPulmonary Exacerbation Treatment Failures

Michael D. Parkins, MD; Jacqueline C. Rendall, MD; J. Stuart Elborn, MD, PhD
Author and Funding Information

From the Departments of Medicine, and Microbiology and Infectious Disease (Dr Parkins), University of Calgary, Calgary, AB, Canada; and Northern Ireland Regional Adult Cystic Fibrosis Centre (Drs Parkins, Rendall, and Elborn), Belfast City Hospital, and Centre for Infection and Immunity (Dr Elborn), Queen’s University of Belfast, Belfast, Ireland.

Correspondence to: Michael D. Parkins, MD, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada; e-mail: mdparkin@ucalgary.ca


Funding/support: Dr Parkins was supported by a Canadian Cystic Fibrosis Foundation Clinical Fellowship grant.

This work has been presented in abstract form at the 2010 North American Cystic Fibrosis Conference in Baltimore, Maryland (Pediatr Pulmonol. 2010;45(S33):327).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):485-493. doi:10.1378/chest.11-0917
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Background:  Pulmonary exacerbations (PEx) are responsible for much of the morbidity and mortality associated with cystic fibrosis (CF). However, there is a paucity of data on outcomes in CF PEx and factors influencing outcomes.

Methods:  We reviewed all PEx in patients infected with Pseudomonas aeruginosa treated with parenteral antibiotics over 4 years at our center. Treatment failures were categorized a priori as those PEx requiring antibiotic regimen change, prolongation of therapy > 20 days because of failure to respond, an early recurrent event within < 45 days, or failure to recover lung function to > 90% of baseline FEV1.

Results:  A total of 101 patients were followed for 452 PEx. Treatment failures were observed in 125 (28%) of PEx; antibiotic regimen change was observed in 27 (6%), prolongation of therapy in 29 (6%), early recurrent events in 63 (14%), and failure to recover lung function to > 90% of baseline FEV1 in 66 (15%). Demographic factors associated with one or more treatment failures per year included advanced airways disease, use of enteric feeds, CF-related diabetes, and CF liver disease but did not include female sex or F508del homozygosity. Increased treatment failure risk was associated with lower admission FEV1 and increased markers of inflammation. At therapeutic completion, increased inflammatory markers correlated with treatment failure. Failure rates decreased with increasing number of active antimicrobial agents used based on in vitro susceptibility (zero, 28/65 [43%]; one, 38/140 [27%]; two, 59/245 [24%]; three, 0/2 [0%]; P = .02).

Conclusions:  One-fourth of PEx fail to respond adequately to initial management. Patient demographic and episode-specific clinical information can be used to identify individuals at increased risk of initial management failure.

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