Zhiling Yuan, Long Kiu Tsang, James Chung Man Ho, Ivan Fan Ngai Hung, Wang Chun Kwok
MDR-PA colonization was uncommon but clinically important among bronchiectasis patients colonized with Pseudomonas aeruginosa in Hong Kong. Medication exposure, particularly PPI, ICS and macrolide use, were associated with MDR-PA colonization. MDR-PA colonization was strongly associated with hospitalization-required exacerbations, supporting the need for early identification of high-risk patients and timely antimicrobial management.
BACKGROUND: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a common colonizer in bronchiectasis patients, associated with worse clinical outcomes. This study aimed to investigate the epidemiology, risk factors, and clinical impacts of MDR-PA colonization among bronchiectasis patients in Hong Kong.
METHODS: This territory-wide retrospective cohort study included adult bronchiectasis patients colonized with Pseudomonas aeruginosa from 2014 to 2023 using the Clinical Data Analysis and Reporting System (CDARS) of the Hospital Authority, Hong Kong. MDR-PA prevalence and associated factors were analyzed. Negative binomial regression with the log of follow-up time as an offset was used to assess the association between MDR-PA colonization and hospitalization-required exacerbations.
RESULTS: Among 5,765 bronchiectasis patients colonized with Pseudomonas aeruginosa, 220 patients had MDR-PA colonization, corresponding to an overall prevalence of 3.82%. In the multivariable logistic regression model, MDR-PA colonization was associated with proton pump inhibitor (PPI) use [adjusted odds ratio (aOR) =1.74, 95% confidence interval (CI): 1.26-2.39], inhaled corticosteroid (ICS) use (aOR =1.41, 95% CI: 1.01-1.98), macrolide therapy (aOR =2.12, 95% CI: 1.56-2.88), and hospitalized exacerbation episodes (aOR =1.09, 95% CI: 1.07-1.11). In the negative binomial regression model, MDR-PA colonization was independently associated with a higher frequency of hospitalization-required exacerbations (adjusted incidence rate ratio =2.07, 95% CI: 1.69-2.52, P<0.001). This association remained consistent when hospitalization-required exacerbation was analyzed as a binary outcome (aOR =2.34, 95% CI: 1.64-3.36, P<0.001).
CONCLUSIONS: MDR-PA colonization was uncommon but clinically important among bronchiectasis patients colonized with Pseudomonas aeruginosa in Hong Kong. Medication exposure, particularly PPI, ICS and macrolide use, were associated with MDR-PA colonization. MDR-PA colonization was strongly associated with hospitalization-required exacerbations, supporting the need for early identification of high-risk patients and timely antimicrobial management.