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Epidemiology

Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

B. D. Edwards, J. Greysson-Wong, R. Somayaji, B. Waddell, F. J. Whelan, D. G. Storey, H. R. Rabin, M. G. Surette, M. D. Parkins
Betty A. Forbes, Editor
B. D. Edwards
aDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada
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J. Greysson-Wong
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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R. Somayaji
aDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada
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B. Waddell
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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F. J. Whelan
eDepartment of Biochemistry and Biomedical Sciences, the Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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D. G. Storey
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
cDepartment of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
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H. R. Rabin
aDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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M. G. Surette
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
dDepartment of Medicine, the Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
eDepartment of Biochemistry and Biomedical Sciences, the Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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M. D. Parkins
aDepartment of Medicine, University of Calgary, Calgary, Alberta, Canada
bDepartment of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
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Betty A. Forbes
Virginia Commonwealth University Medical Center
Roles: Editor
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DOI: 10.1128/JCM.02556-16
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  • FIG 1
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    FIG 1

    Natural history of chronic infection with Achromobacter species. The incidence of Achromobacter isolation by time is shown for patients with persistent infection. The age at incident Achromobacter infection is documented. Species were identified as Achromobacter spp. at initial culture and continued with this designation if the isolate was not recoverable (discarded or nonviable) from the biobank for species analysis.

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    FIG 2

    Dendrogram for pulsed-field gel electrophoresis of Achromobacter isolates recovered from the Calgary Adult CF Clinic biobank and assessed for natural history and epidemiology. Designations show patient-strain-date (day/month/year).

Tables

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  • TABLE 1

    Demographics of patients with Achromobacter sp. infectiona

    ParameterValue for groupP valued
    Total (n = 34)Transient infection (n = 24)Persistent infection (n = 10)Controls (n = 18)Transient infection vs persistent infectionPersistent infection vs controls
    Median age (IQR)24 (20.3–29.8)25 (21.0–30.3)24 (19.3–27.3)22 (18.0–25.8)0.800.45
    No. (%) of males15 (44.1)9 (37.5)6 (60.0)11 (61.1)0.230.95
    Median BMI (IQR)20 (18.3–21.4)20 (18.4–21.1)19 (18.2–21.8)21 (19.2–23.1)0.760.50
    No. (%) of patients with pancreatic insufficiency29 (85.3)20 (83.3)9 (90.0)13 (72.2)0.620.27
    Median FVC% (IQR)73 (56.3–95.8)69 (56.8–102.3)75 (54.8–85.5)86 (64.8–104.8)0.250.11
    Median FEV1% (IQR)51 (35.5–81.3)47 (34.5–87.3)57 (38.3–75.5)66 (43.3–88.5)0.630.22
    No. (%) of patients with home O24 (11.8)3 (12.5)1 (10.0)0 (0.0)0.840.17
    No. (%) of patients who received:
        Inhaled tobramycinb7 (20.6)5 (20.8)2 (20.0)4 (22.2)0.960.89
        Azithromycinb4 (11.8)3 (12.5)1 (10.0)4 (22.2)0.840.42
        Inhaled corticosteroid8 (23.5)3 (12.5)5 (50.0)3 (16.7) 0.02 0.06
    No. (%) of patients with chronic coinfection
        P. aeruginosa28 (82.4)20 (83.3)8 (80.0)12 (66.6)0.820.45
        S. aureus25 (73.5)17 (70.8)8 (80.0)7 (38.8)0.58 0.04
    No. (%) of patients with comorbidityc
        CFRD5 (14.7)3 (12.5)2 (20.0)3 (16.7)0.570.83
        Sinus disease10 (29.4)6 (25.0)4 (40.0)10 (55.6)0.380.43
        Bone disease9 (26.5)7 (29.2)2 (20.0)4 (22.2)0.580.89
        CFLD8 (23.5)6 (25.0)2 (20.0)2 (11.1)0.750.52
        DIOS3 (8.8)3 (12.5)0 (0.0)2 (11.1)0.240.27
    • ↵a Baseline data are from the 2 years prior to incident Achromobacter culture. Note that the “persistent” cohort included a 10th patient who was unable to be compared to control patients for clinical outcomes.

    • ↵b Azithromycin or tobramycin use at time of Achromobacter sp. culture or control study entry.

    • ↵c CFRD, CF-related diabetes; CFLD, CF liver disease; DIOS, distal intestinal obstruction syndrome.

    • ↵d Values in bold indicate those which were statistically significant.

Additional Files

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    • Supplemental file 1 -

      Fig. S1 (Individual demographics of adult CF patients at incident Achromobacter isolation) and S2 (Quantification of biofilm production by Achromobacter isolates)

      PDF, 180K

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Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study
B. D. Edwards, J. Greysson-Wong, R. Somayaji, B. Waddell, F. J. Whelan, D. G. Storey, H. R. Rabin, M. G. Surette, M. D. Parkins
Journal of Clinical Microbiology Jun 2017, 55 (7) 2074-2085; DOI: 10.1128/JCM.02556-16

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Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study
B. D. Edwards, J. Greysson-Wong, R. Somayaji, B. Waddell, F. J. Whelan, D. G. Storey, H. R. Rabin, M. G. Surette, M. D. Parkins
Journal of Clinical Microbiology Jun 2017, 55 (7) 2074-2085; DOI: 10.1128/JCM.02556-16
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    • ABSTRACT
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KEYWORDS

Achromobacter
cystic fibrosis
Gram-Negative Bacterial Infections
Achromobacter xylosoxidans
infection transmission
emerging infections
epidemiology
eradication
infection control
inhaled corticosteroids
multilocus sequence typing
pulsed-field gel electrophoresis
whole-genome sequencing

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