<i>Pseudomonas aeruginosa</i> eradication therapy and risk of acquiring <i>Aspergillus</i> in young children with cystic fibrosis.

Abstract

While <i>Aspergillus</i> detection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown. To determine the risk and explanatory factors of acquiring <i>Aspergillus</i> in children with CF by age 5 years. Cross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detecting <i>Aspergillus</i> at age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiring <i>Aspergillus</i> and <i>Pseudomonas aeruginosa</i> from birth until age 5 years. Cross-sectional analysis found that the number of <i>P. aeruginosa</i> eradication courses increased the odds of detecting <i>Aspergillus</i> at age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the first <i>P. aeruginosa</i> positive culture was 2.38 (1.32-3.79) years and 3.69 (1.68-4.74) years for the first <i>Aspergillus</i> positive culture. The risk of <i>P. aeruginosa</i> and <i>Aspergillus</i> events changes with time after the first year of study entry. It also decreases for <i>P. aeruginosa</i> after completing <i>P. aeruginosa</i> eradication (HR 0.15, 95% CI 0.00 to 0.79), but increases for <i>Aspergillus</i> events (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event. In young children with CF, completing <i>P. aeruginosa</i> eradication therapy and previous <i>Aspergillus</i> events are associated with increased risk of acquiring <i>Aspergillus</i>.