Objectives Pseudomonas aeruginosa (P. aeruginosa) occupies an important niche in the pathogenic microbiome of bronchiectasis. The objective of this study is to evaluate the clinical characteristics and prognostic value of P. aeruginosa in Chinese adult patients with bronchiectasis.
Methods This retrospective and follow-up study enrolled 1188 patients diagnosed with bronchiectasis at Shanghai Pulmonary Hospital between January 2011 and December 2012. The patients’ clinical data including anthropometry, clinical symptoms, serum biomarkers, radiographic manifestations and lung function indices were reviewed. The median follow-up duration (IQR) was 44 (40-54) months, during which 289 patients were lost to follow-up. Data from 899 patients were collected and analysed for the outcomes of mortality, annual exacerbation frequency and health-related quality of life.
Results P. aeruginosa was isolated from 232 patients, alongside other pathogens such as Aspergillus (n=75) and Candida albicans (n=72). There were 74 deaths (12% of patients with P. aeruginosa, 7.3% of those without) over the course of the follow-up. The isolation of P. aeruginosa was a risk factor for all-cause mortality (HR, 3.07; 95% CI 1.32 to 7.15) and was associated with high rates of exacerbations (ie, ≥3 exacerbations per year of follow-up) (HR, 2.40; 95% CI 1.20 to 4.79). Patients with P. aeruginosa also had worse scores on the Hospital Anxiety and Depression Scale (anxiety, p=0.005; depression, p<0.001), the Leicester Cough Questionnaire (p=0.033) and the modified Medical Research Council scale (p=0.001) compared with those without P. aeruginosa.
Conclusions Isolation of P. aeruginosa in patients with bronchiectasis is a significant prognostic indicator and should be a major factor in the clinical management of the disease.
- pseudomonas aeruginosa
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HW, X-BJ and BM contributed equally.
Contributors HW, XBJ, BM and JFX designed the study, collected the data, developed the plan for analysis, analysed the data, drafted and revised the paper. CWL and HWL contributed substantially to the study design, data analysis and the drafting of the manuscript.
Funding This work was supported by the National Science Foundation of China (81670006); Shanghai Leading Talent Program (No. 2016036) and Shanghai Hospital Development Center Program (16CR3036A).
Competing interests None declared.
Patient consent Obtained.
Ethics approval Ethics Committee of Shanghai Pulmonary Hospital (k17-141)
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.
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