Sputum Candida albicans presages FEV₁ decline and hospital-treated exacerbations in cystic fibrosis.
Authors
Chotirmall, Sanjay HO'Donoghue, Elaine
Bennett, Kathleen
Gunaratnam, Cedric
O'Neill, Shane J
McElvaney, Noel G
Affiliation
Department of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland. schotirmall@rcsi.ieIssue Date
2010-11MeSH
AdultAnti-Bacterial Agents
Body Mass Index
Candida albicans
Candidiasis
Colony Count, Microbial
Cystic Fibrosis
Disease Progression
Female
Follow-Up Studies
Forced Expiratory Volume
Humans
Incidence
Male
Prognosis
Prospective Studies
Recurrence
Sputum
Young Adult
Metadata
Show full item recordCitation
Sputum Candida albicans presages FEV₁ decline and hospital-treated exacerbations in cystic fibrosis. 2010, 138 (5):1186-95 ChestJournal
ChestDOI
10.1378/chest.09-2996PubMed ID
20472859Abstract
The role of Candida albicans in the cystic fibrosis (CF) airway is underexplored. Considered a colonizer, few question its pathogenic potential despite high isolation frequencies from sputum culture. We evaluated the frequency and identified the strongest predictors of C albicans colonization in CF. Independent associations of colonization with clinical outcomes were determined, and the longitudinal effects of C albicans acquisition on BMI and FEV₁ were evaluated.A prospective observational study of 89 patients with CF was performed (3,916 sputum samples over 11 years). Frequency of C albicans growth in sputum allowed classification of the cohort into colonizers and noncolonizers. BMI, FEV₁, hospital-treated exacerbations, and other clinical parameters were followed throughout the study to determine association with colonization status. Multivariate regression determined the strongest predictors of colonization and for clinical effects after adjustment for confounders. Repeated-measures analysis of variance assessed the longitudinal effect of colonization on BMI and FEV₁.
Colonization with C albicans was frequent (49.4%) and best predicted by pancreatic insufficiency (P = .014), osteopenia (P = .03), and cocolonization with Pseudomonas species (P = .002). C albicans colonization significantly predicted hospital-treated exacerbations (P = .004) after adjustment for confounders. Exacerbation rate significantly increased in patients with chronic or intermittent colonizations following first acquisition of C albicans. Colonization accelerated rates of decline for BMI (P < .0001) and FEV₁ (P < .001).
Airway colonization with C albicans presaged a greater rate of FEV₁ decline and hospital-treated exacerbations in CF.
Item Type
ArticleLanguage
enISSN
1931-3543ae974a485f413a2113503eed53cd6c53
10.1378/chest.09-2996