The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

Ann Med. 2021 Dec;53(1):459-469. doi: 10.1080/07853890.2021.1900594.

Abstract

Objectives: The impact of Pseudomonas aeruginosa on the prognosis of bronchiectasis remains controversial. This study aimed to explore the prognostic value of P. aeruginosa in adult patients with bronchiectasis in central-southern China.

Patients and methods: This prospective cohort study enrolled 1,234 patients with bronchiectasis between 2013 and 2019. The independent impact of P. aeruginosa on all-cause mortality, annual exacerbations, and hospitalizations was assessed.

Results: P. aeruginosa was isolated from 244 patients (19.8%). A total of 188 patients died over a follow-up period of 16 (1-36) months. Patients with P. aeruginosa had a longer disease course, poorer lung function, more lung lobe involvement, and more severe Bronchiectasis Severity Index (BSI) stage than those without P. aeruginosa. The independent impact of P. aeruginosa was observed on frequent hospitalizations but not on mortality and frequent exacerbations. Moderate- or high-risk comorbidities increased the risk of mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.26-2.95), and this effect was magnified by the presence of P. aeruginosa (HR: 2.11, 95% CI: 1.28-3.48).

Conclusions: P. aeruginosa infection acts as a marker of disease severity as well as predictor of frequent hospitalizations. P. aeruginosa had no independent effect on all-cause mortality. P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.KEY MESSAGE:P. aeruginosa increased the risk of frequent hospitalizations; however, it had no independent impact on all-cause mortality.P. aeruginosa combined with moderate- or high-risk comorbidities posed an increased risk of mortality.The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.

Keywords: Bronchiectasis; Pseudomonas aeruginosa; hospitalizationsexacerbations; mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchiectasis / complications*
  • Bronchiectasis / mortality
  • China / epidemiology
  • Comorbidity
  • Hospitalization / statistics & numerical data
  • Humans
  • Prognosis
  • Prospective Studies
  • Pseudomonas Infections / complications
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas Infections / epidemiology
  • Pseudomonas aeruginosa / isolation & purification*
  • Respiratory Function Tests
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate

Substances

  • Anti-Bacterial Agents

Grants and funding

This study was supported by the National Natural Science Foundation of China (81470202, 81770002, 82070003, 81900002), Natural Science Foundation of Hunan Province, China (2020JJ5805), Fundamental Research Funds for Central Universities of Central South University (2020zzts292, 2020zzts281), the Hunan Provincial Innovation Foundation For Postgraduate (CX20200289), the Hunan Province Health Commission Scientific Research Project (B2019159), the Science and Technology Program of Changsha, China (kq1901120), Xiangya Clinical Big Data System Construction Project in Pulmonary Inflammatory Disease of Central South University, and the National Key Clinical Specialty Construction Projects of China.