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Risk factors for allergic bronchopulmonary aspergillosis in paediatric patients with cystic fibrosis
  1. J Bird1,
  2. C O’Brien2,
  3. S Moss2
  1. 1Medical Student Education, Newcastle University Medical School, Newcastle, UK
  2. 2Respiratory Paediatrics, Newcastle-upon-Tyne Hospitals NHS Trust, Newcastle, UK

Abstract

Introduction Allergic bronchopulmonary aspergillosis (ABPA) is increasingly prevalent among cystic fibrosis (CF) patients. Atopy, sex, season at diagnosis and cystic fibrosis transmembrane conductance regulator (CFTR) mutation are suggested risk factors for ABPA. Studies indicate that centres using a high amount of intravenous antibiotics have better outcomes, but this has also been linked to the increase in ABPA. The objective of this retrospective case-control study was to assess potential risk factors for ABPA, in particular intravenous antibiotic use.

Methods Of 150 paediatric patients, 13 fulfilled the CF foundation consensus diagnostic criteria for ABPA. These were compared to 130 patients without evidence of ABPA. Seven patients were excluded from the study as they showed evidence of ABPA but did not fulfil the diagnostic criteria. The intravenous antibiotic data for the ABPA group was compared to 80 patients without ABPA using extended matching by age of diagnosis. The data collected included age, sex, CFTR mutation, atopy (history or family history of diagnosed hay fever, eczema or asthma), and weeks of intravenous antibiotics administered. Season of diagnosis was noted for the ABPA group.

Results The median duration of use of intravenous antipseudomonal antibiotics in the ABPA group was 38 weeks, compared to 5 weeks in the non-ABPA group (p<0.05). No difference was found in the duration of use of non-antipseudomonal antibiotics (median 12 weeks in ABPA group, 2 weeks in non-ABPA group). The average time since diagnosis of CF was higher in the ABPA group by 3 years (p=0.01). 12/13 (92%) of ABPA patients had a history of atopy compared to 50/105 (47%) of the non-ABPA group (p=0.05). There was no difference in CFTR mutation, sex or season of ABPA diagnosis.

Conclusion Intravenous antipseudomonal antibiotic use was substantially higher in the ABPA population. This could be a factor in the increase in ABPA, suggesting that tighter microbiological guidance may be useful before initiating antibiotic treatment. However, this could also be that IV use and ABPA are both markers for increased disease severity. Atopy was also significantly higher in the ABPA population. This could potentially be used to highlight those CF patients at risk from this disease.

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