Mark L Metersky1, Timothy R Aksamit2, Alan Barker3, Radmila Choate4, Charles L Daley5, Leigh A Daniels6, Angela DiMango7, Edward Eden8, David Griffith9, Margaret Johnson10, Michael Knowles11, Anne E O'Donnell12, Kenneth Olivier13, Matthias Salathe14, Byron Thomashow15, Gregory Tino16, Gerard Turino8, Kevin L Winthrop3, David Mannino4. 1. 1 Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. 2. 2 Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. 3. 3 Oregon Health and Science University, Portland, Oregon. 4. 4 University of Kentucky College of Public Health, Lexington, Kentucky. 5. 5 Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, Colorado. 6. 6 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 7. 7 Columbia University/New York Presbyterian Hospital, New York, New York. 8. 8 Icahn School of Medicine at Mount Sinai, New York, New York. 9. 9 University of Texas Health Sciences Center at Tyler, Tyler, Texas. 10. 10 Mayo Clinic Florida, Jacksonville, Florida. 11. 11 University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. 12. 12 Georgetown University Hospital, Washington, DC. 13. 13 National Institute of Allergy and Infectious Diseases, Bethesda, Maryland. 14. 14 University of Miami, Miller School of Medicine, Miami, Florida. 15. 15 Center for Chest Disease, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York; and. 16. 16 University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Abstract
RATIONALE: Staphylococcus aureus is commonly cultured from the sputum of patients with bronchiectasis; however, little is known about the prevalence of the organism in these patients, the characteristics of patients who have grown the organism, or its implications. OBJECTIVES: Determine the relationship between S. aureus and pulmonary function, frequency of exacerbations, and frequency of hospitalization in patients with bronchiectasis Methods: The Bronchiectasis Research Registry is a database of adults with non-cystic fibrosis bronchiectasis identified from 13 sites within the United States. Baseline and follow-up demographic, spirometric, microbiologic, and therapeutic data were entered into a central web-based database. Patients were grouped into three cohorts based on their previous respiratory cultures at the time of entry into the Registry: 1) no prior S. aureus or glucose-nonfermenting gram-negative bacilli (NF-GNB) (Pseudomonas, Stenotrophomonas, or Burkholderia spp.); 2) prior S. aureus at least once; or 3) no prior S. aureus but prior NF-GNB at least once. The association between S. aureus isolation and pulmonary function and frequency of exacerbations and hospital admissions was assessed, both at baseline and after 1 year of follow-up. RESULTS: S. aureus was cultured from 94 of 830 patients (11.3%) included in the analysis. Patients who had grown S. aureus before entry into the Registry had a frequency of prior exacerbations and baseline pulmonary function that was between that of patients who had grown NF-GNB and those who had grown neither NF-GNB or S. aureus. Similarly, at the first follow-up visit after study entry, patients who had grown S. aureus had a frequency of exacerbations and hospitalizations that was between those of patients who had grown NF-GNB and those who had grown neither NF-GNB nor S. aureus. However, in multivariate analysis, S. aureus was not associated with pulmonary function, frequency of exacerbation, or hospital admissions. There were no significant differences in patient characteristics or outcomes between patients who had methicillin-sensitive and methicillin-resistant S. aureus. CONCLUSIONS: Staphylococcus aureus does not appear to be an independent risk factor for severe disease in patients with bronchiectasis enrolled in the Bronchiectasis Research Registry.
RATIONALE: Staphylococcus aureus is commonly cultured from the sputum of patients with bronchiectasis; however, little is known about the prevalence of the organism in these patients, the characteristics of patients who have grown the organism, or its implications. OBJECTIVES: Determine the relationship between S. aureus and pulmonary function, frequency of exacerbations, and frequency of hospitalization in patients with bronchiectasis Methods: The Bronchiectasis Research Registry is a database of adults with non-cystic fibrosis bronchiectasis identified from 13 sites within the United States. Baseline and follow-up demographic, spirometric, microbiologic, and therapeutic data were entered into a central web-based database. Patients were grouped into three cohorts based on their previous respiratory cultures at the time of entry into the Registry: 1) no prior S. aureus or glucose-nonfermenting gram-negative bacilli (NF-GNB) (Pseudomonas, Stenotrophomonas, or Burkholderia spp.); 2) prior S. aureus at least once; or 3) no prior S. aureus but prior NF-GNB at least once. The association between S. aureus isolation and pulmonary function and frequency of exacerbations and hospital admissions was assessed, both at baseline and after 1 year of follow-up. RESULTS:S. aureus was cultured from 94 of 830 patients (11.3%) included in the analysis. Patients who had grown S. aureus before entry into the Registry had a frequency of prior exacerbations and baseline pulmonary function that was between that of patients who had grown NF-GNB and those who had grown neither NF-GNB or S. aureus. Similarly, at the first follow-up visit after study entry, patients who had grown S. aureus had a frequency of exacerbations and hospitalizations that was between those of patients who had grown NF-GNB and those who had grown neither NF-GNB nor S. aureus. However, in multivariate analysis, S. aureus was not associated with pulmonary function, frequency of exacerbation, or hospital admissions. There were no significant differences in patient characteristics or outcomes between patients who had methicillin-sensitive and methicillin-resistant S. aureus. CONCLUSIONS:Staphylococcus aureus does not appear to be an independent risk factor for severe disease in patients with bronchiectasis enrolled in the Bronchiectasis Research Registry.
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