Achromobacter xylosoxidans airway infection is associated with lung disease severity in children with cystic fibrosis

Charlotte Marsac; Laura Berdah; Guillaume Thouvenin; Isabelle Sermet-Gaudelus; Harriet Corvol

doi:10.1183/23120541.00076-2021

Achromobacter xylosoxidans airway infection is associated with lung disease severity in children with cystic fibrosis

ERJ Open Res. 2021 May 31;7(2):00076-2021. doi: 10.1183/23120541.00076-2021. eCollection 2021 Apr.

Authors

Charlotte Marsac^{1

2}, Laura Berdah¹, Guillaume Thouvenin¹, Isabelle Sermet-Gaudelus², Harriet Corvol¹

Affiliations

¹ Paediatric Pulmonology Dept and Cystic Fibrosis Centre, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMR_S938, AP-HP, Hôpital Trousseau, Paris, France.
² Paediatric Pulmonology Dept and Cystic Fibrosis Centre, Université de Paris, Inserm U 1151, AP-HP, Hôpital Necker Enfants Malades, Paris, France.

Abstract

Background: Despite the increasing prevalence of Achromobacter xylosoxidans lung infection in patients with cystic fibrosis (CF), its clinical pathogenicity remains controversial. The objective of this study was to evaluate the effects of this emerging bacterium on lung disease severity in CF children.

Methods: This case-control retrospective study took place in two French paediatric CF centres. 45 cases infected by A. xylosoxidans were matched for age, sex, CFTR genotypes and pancreatic status to 45 never-infected controls. Clinical data were retrieved from clinical records over the 2 years before and after A. xylosoxidans initial infection.

Results: At infection onset, lung function was lower in cases compared with controls (p=0.006). Over the 2 years prior to A. xylosoxidans acquisition, compared with controls, cases had more frequent pulmonary exacerbations (p=0.02), hospitalisations (p=0.05), and intravenous (p=0.03) and oral (p=0.001) antibiotic courses. In the 2 years following A. xylosoxidans infection, cases remained more severe with more frequent pulmonary exacerbations (p=0.0001), hospitalisations (p=0.0001), and intravenous (p=0.0001) and oral antibiotic courses (p=0.0001). Lung function decline tended to be faster in cases (-5.5% per year) compared with controls (-0.5% per year).

Conclusions: This case-control study demonstrates that A. xylosoxidans occurs more frequently in the patients with the worse lung disease. Further studies assessing the pathogenicity of this emerging pathogen and international treatment recommendations are warranted.