# 1226 Clinical outcomes of Achromobacter species in adult ... · (1984 – 2013) 306 CF Patients...

(1984– 2013)306CFPatients

34(11%)Patients≥1sputum(+)withAchromobacter

24TransientColonizers 10(3.3%)Persistentcolonizers≥50%ofallculturesina1-yearperiod

(minimumof3cultures)≥1positivecultureandnotmeeting

criteriafor“persistent”

ClinicaloutcomesofAchromobacterspeciesinadultcysticfibrosispatients:Acohortstudy

Edwards BD,1 Somayaji R,1, Greysson-Wong J,2 Storey DG,3 Rabin HR,1,2 Surette MG,2,4.5 Parkins MD1,2

Background

• Achromobacter speciesareemergingpathogensincysticfibrosis(CF)withreportedprevalencerangingfrom5-29%

• Thereisapaucityofknowledgeregardingthepathogenicity,transmissioncharacteristics,andclinicalimpact ofthisorganism

Methods

• PatientsattendingtheSouthernAlbertaAdultCFclinicbetween1984– 2013with≥1sputumculturepositiveforAchromobacterspecieswereincluded

• Patientswerecategorizedintotransientandpersistentforanalysis(Figure1);thosewithpersistentinfectionwerealsomatched1:2withasexandage-matchedcontrolCFcohortforanalysis

• Datawascollectedthroughchartreviewtwoyearspre- andpost-initialAchromobacterinfection

• Achromobacterisolateswerecharacterizedwith16srRNA,PFGE,andnrdA genesequencing forspeciationanddetectionofclonality

• Outcomesofpulmonaryexacerbation(PEx)riskatinitialacquisitioncomparedwithpre- andpost-infection,lungfunctiondecline(FEV1%/year)andPExriskpre- andpost-infectionwereassessedwithregressionmodelsusingSTATA14.1(CollegeStn,TX)

• Atotalof34/306patients(11%)withamedianageof24.8yearswereidentifiedwithAchromobacterinfectioninthestudyperiod(Figure1)

• OfthosewithAchromobacterinfection,10/306(3.3%)developedpersistentinfectionandA.xylosoxidanswasthemostcommonspecies(50.0%)(Figure2)

• PatientsweremorelikelytoexperiencePExatinitialisolation(OR2.7;[95%CI1.2– 6.7];p=0.03)comparedwiththepriororsubsequentvisit

• BaselinecharacteristicsofpatientswithAchromobacterinfectionsandcontrolsweresimilar(Table1)

• Therewasnodifferenceinannuallungfunctiondecline(-1.08%[95%CI-2.73-0.57]vs.-2.74%[95%CI-4.02- -1.46];p=0.12)oroddsofPEx(OR1.21[95%CI0.45-3.28];p=0.70)followingpersistentAchromobacterinfection

• Twopatients(A182– apersistent colonizerandA184– atransientcolonizer)culturedAchromobacterxylosoxidans withmatchingPFGEandnrdA profiles(Figure3*)reflectingapossibletransmissionevent

• OtherinfectingspeciesidentifiedbynrdA sequencingwere A.insuavis(28%),A.dolens(11%),A.spanius(6%),andA.ruhlandii(6%)

• Therateoflungfunctiondeclinewasnotdifferentamongstspecies

UniversityofCalgary3330HospitalDriveNWCalgary,ABCANADA,T2N4N1Michael.parkins@me.com

#1226

• AchromobacterspecieshadaprevalenceandspeciesdistributionsimilartootherCFbasedstudiesinourcenter

• Achromobacter infectionwasassociatedwithPExatinitialacquisitionbutdidnothaveasignificantimpactonPExriskorrateofFEV1%declinefollowinginfection

• Largerstudiesarerequiredtoelucidatethetransmissionpotentialofthisorganism

Conclusions

DepartmentofMedicine1,DepartmentofMicrobiology,Immunology,andInfectiousDiseases2,DepartmentofBiologicalSciences3:UniversityofCalgary;DepartmentofMedicine4 andBiochemistry5,TheFarncombeFamily

DigestiveHealthResearchInstitute,McMasterUniversity

100806040

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}*

Aim

• Todeterminetheepidemiology,transmissibility,andclinicaloutcomesofAchromobacterspeciesinaNorthAmericanCFcohort

Table1:Baselinedataoftransient,persistentandcontrolcohorts

Baselinedata:2yearspriortoincidentAchromobacter culture*AzithromycinortobramycinattimeofAXcultureorControlstudyentry;✝Chronicco-infection;CFRD– CFrelateddiabetes;CFLD- CFliverdisease;DIOS– DistalIntestinalObstructionSyndrome

Figure1.Patientrecruitment

Figure3.DendogramofAchromobacterPFGE

Results

Figure2.Evolutionofchronicinfection

Total(n=34)

Transient(n=24)

Persistent(n=10)

Controls(n=18)

P-value(Transientvs.Persistent)

P-value(Persistentvs.

Control)Age,mean(SD) 26(9.3) 26(6.6) 27(14.3) 23(6.8) 0.8 0.45Male,no.(%) 15(44.1) 9(37.5) 6(60.0) 11(61.1) 0.23 0.95BMI(SD) 20(3.0) 20(2.8) 20(3.6) 21(2.7) 0.76 0.5

PancreaticInsufficiency,no.(%) 29(85.3) 20(83.3) 9(90.0) 13(72.2) 0.62 0.27FVC%,mean(SD) 77(26.8) 81(28.5) 70(21.6) 86(26.2) 0.25 0.11FEV1%, mean(SD) 58(27.1) 60(29.1) 55(22.6) 67(26.6) 0.63 0.22

*Inhaledtobramycin,no.(%) 7(20.6) 5(20.8) 2(20.0) 4(22.2) 0.96 0.89* Azithromycin,no.(%) 4(11.8) 3(12.5) 1(10.0) 4(22.2) 0.84 0.42InhaledCorticosteroid,no.(%) 8(23.5) 3(12.5) 5(50.0) 3(16.7) 0.02 0.06�P. aeruginosa,no.(%) 28(82.4) 20(83.3) 8(80.0) 12(66.6) 0.82 0.45�S. aureus,no.(%) 25(73.5) 17(70.8) 8(80.0) 7(38.8) 0.58 0.04HomeO2,no. (%) 4(11.8) 3(12.5) 1(10.0) 0(0.0) 0.84 0.17Co-Morbidities: - - - - - -CFRD,no.(%) 5(14.7) 3(12.5) 2(20.0) 3(16.7) 0.57 0.83SinusDisease,no.(%) 10(29.4) 6(25.0) 4(40.0) 10(55.6) 0.38 0.43BoneDisease,no.(%) 9(26.5) 7(29.2) 2(20.0) 4(22.2) 0.58 0.89CFLD,no.(%) 8(23.5) 6(25.0) 2(20.0) 2(11.1) 0.75 0.52DIOS,no.(%) 3(8.8) 3(12.5) 0(0.0) 2(11.1) 0.24 0.27

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 /// 2007 2008 2009 2010 2011 2012 2013

Patient 6

Patient 9

Patient 12

Patient 18

Patient 21

Patient 23

Patient 24

Patient 25

Patient 26

Patient 33

A. xylosoxidans

A. xylosoxidans

A. xylosoxidans

= Death

= Lung Transplant

A. insuavis*

Unidentified species

A. xylosoxidans

A. insuavis

A. spanius

Unidentified species

* = Patient lost to follow-up (no sputum collected during this interim period)= Incidence of isolation of Achromobacter; Unless otherwise indicated, end of

boxes indicates spontaneous clearance.

A. xylosoxidans

= Period of clinic follow-up, including ongoing sputum culture = Moved to another center

Age: 25

Age: 16

Age: 63

Age: 20

Age: 28

Age: 15

Age: 24

Age: 23

Age: 39

Age: 19

Legend:Patient– Strain– Date(DD/MM/YYYY)