Pseudomonas aeruginosa enfeksiyonunun kistik fibrozis dışı bronşiektazi hastalarında alevlenme ve hastane yatışı ile ilişkisinin incelenmesi
Özet
Objective: Bronchiectasis is a disease characterized clinically by cough and sputum and morphologically by persistent dilatation and thickening of the bronchial wall. Pseudomonas aeruginosa is one of the most important pathogens in non-cystic fibrosis bronchiectasis and is associated with impaired respiratory function, increased hospitalization rates and high mortality. Early detection and eradication improves the clinical course of these patients and reduces the high cost of treatment. The aim of this thesis was to investigate the association of Pseudomonas aeruginosa infection with pulmonary function, exacerbation and hospitalization in adult non-cystic fibrosis bronchiectasis patients.
Method: The last 3-year data of patients older than 18 years of age who were diagnosed with non-cystic fibrosis bronchiectasis between January 2018 and January 2023 in Hacettepe University Faculty of Medicine, Department of Chest Diseases were retrospectively analyzed. Demographic data, smoking, pulmonary function, sputum microbiology, clinical exacerbation and hospitalization, comorbidity, treatment, radiological findings were analyzed according to Pseudomonas aeruginosa culture results.
Results: Of the 130 patients followed between 2014-2023, 63.8% were female and the mean age was 41.6±19.4 years. Exacerbation was detected in 42.3% of patients in the last 1 year, 72.3% in the last 2-3 years, hospitalization was detected in 14.6% in the last 1 year and 25.4% in the last 2-3 years. The most common comorbidity was asthma (29.2%). P. aeruginosa (24.6%) was the most common sputum culture organism in the last 1 year. It was observed that 31.2% of those with positive P. aeruginosa culture in the last 1 year received inhaled Tobramycin-Colistin. The most common involvement was seen in the left lung in the first and last thorax CT scans. According to occupational groups, 59.2% were non-employed, 55.4% were born in Central Anatolia and 76.2% lived in Central Anatolia. It was observed that 65% of the patients with positive P. aeruginosa results in the left 1 year had positive culture results in the last 2-3 years, and this relationship was found to be significant (p<0.001). The high rate of inhaler therapy use in the P. aeruginosa positive group was statistically significant (p=0.006). In the first pulmonary function test, the mean FEV1 and FVC expected (%) value of patients with negative P. aeruginosa results were significantly higher than those with positive results (p=0.022), (p=0.016). In the last pulmonary function test, mean FEV1 and FVC expected (%) values were not different between the groups with positive and negative culture results. When the groups with and without culture results were compared, exacerbations in the last 1 year (p<0.001) and in the last 2-3 years (p=0.006) were significantly higher in the group with culture results. When the groups with negative and positive P. aeruginosa culture results were compared, hospitalizations in the last 1 year and last 2-3 years were significantly higher in the positive group (p=0.001), (p=0.015).
Conclusion: The frequency of respiratory tract infections in childhood, ease of access to thoracic CT, and the fact that it is a reference center may decrease the mean age for the diagnosis of bronchiectasis. Since P. aeruginosa culture positivity varies between communities, community-specific studies are of great importance in determining diagnosis and treatment strategies. When deterioration in FEV1 and FVC is detected in the follow-up of patients with bronchiectasis, sputum P. aeruginosa investigation may provide early colonization detection and slow the transition to chronic ground. It was observed that hospitalization was a worse clinical picture than exacerbation and this was strongly associated with P. aeruginosa positivity. We suggest that more widespread use of inhaled Tobramycin-Colistin therapy should be reviewed in patients with P.aeruginosa culture positivity. The use of standardized forms for the diagnosis, treatment and follow-up of bronchiectasis patients will provide an opportunity for comprehensive research by creating a healthy database.
