Şeyda Karabulut, Merve Selçuk Balcı, Mine Yüksel Kalyoncu, Aynur Gulieva, Mürüvvet Yanaz, Cansu Yılmaz Yeğit, Almala Pınar Ergenekon, Burcu Uzunoğlu, Gamze Taştan, Özgenur Demirkol, Ela Erdem Eralp, Yasemin Gökdemir, Ayşegül Karahasan, Fazilet Karakoç, Bülent Karadağ
In this pre-cystic fibrosis transmembrane conductance regulator modulator study, persistence of Ach was associated with older age, higher Pex burden before first isolation, and clinically relevant shifts in airway microbiology, including increased PA colonization. Our findings suggest that cwCF with frequent exacerbations or a worsening clinical course may warrant closer attention to Ach, and eradication of Ach may be considered at first detection.
OBJECTIVE: We aimed to describe the clinical and demographic characteristics of children with cystic fibrosis (cwCF) diagnosed with a first Achromobacter (Ach) isolation, and to evaluate treatment outcomes at our CF center during the pre-modulator era.
MATERIAL AND METHODS: We retrospectively reviewed children followed at a single CF center (2014-2021) with at least four respiratory cultures per year and ≥12 months of follow-up after first Ach isolation. Eradication was defined as no Ach isolation for 12 months after the first detection; persistent infection was defined as intermittent or chronic isolation according to the Leeds criteria. We compared clinical characteristics and 12-month outcomes between the eradicated and non-eradicated groups.
RESULTS: Forty children were included; mean age at first isolation was 10.9±7.0 years, and eradication was achieved in 19/40 (47.5%). The non-eradicated group was older at first isolation (12.7±8.0 vs. 8.5±5.1 years; P = 0.04), had more pulmonary exacerbations (Pex) in the preceding year (median 4 vs. 2; P = 0.01), and more frequent prophylactic azithromycin use (67% vs. 21%; P = 0.01). Airway colonization patterns changed significantly over 12 months in the non-eradicated group (P < 0.001), with increased colonization by Pseudomonas aeruginosa (PA); changes were not significant in the eradicated group. Among those with available spirometry, 12-month forced expiratory volume in one second (FEV1) z-scores did not differ by eradication status after adjustment for the baseline FEV1 z-score.
CONCLUSION: In this pre-cystic fibrosis transmembrane conductance regulator modulator study, persistence of Ach was associated with older age, higher Pex burden before first isolation, and clinically relevant shifts in airway microbiology, including increased PA colonization. Our findings suggest that cwCF with frequent exacerbations or a worsening clinical course may warrant closer attention to Ach, and eradication of Ach may be considered at first detection.