The Clinical Association between Aspergillus fumigatus and Respiratory Outcomes in Adolescents and Adults with Cystic Fibrosis

作者：Anna L. O’Dea, Rui Feng, Laurel Glaser, Christina Kubrak, Ronald C. Rubenstein, Daniel Dorgan, Denis Hadjiliadis, Steven M. Kawut, Gina Hong · 发表于：Annals of the American Thoracic Society · 年份：2023 · DOI：10.1513/annalsats.202210-852oc · 被引用次数：16 · 研究领域：Cystic Fibrosis Research Advances、Antifungal resistance and susceptibility、Asthma and respiratory diseases

Abstract Rationale The clinical significance of Aspergillus fumigatus (Af) detection in the absence of allergic bronchopulmonary aspergillosis in cystic fibrosis (CF) airways remains unclear. Yet, some clinicians initiate antifungal therapy for Af-positive respiratory cultures out of concern for infection in people with CF. Objectives To determine the association between the presence of Af and respiratory outcomes in individuals with CF. Methods We conducted a prospective longitudinal cohort study of 206 adults and adolescents (age 14 yr and older) with CF and collected sputum for selective fungus culture. We assessed clinical outcome measurements, including patient-reported outcomes (measured by the Cystic Fibrosis Questionnaire–Revised), spirometry, and number of pulmonary exacerbations (PEx) for a 1-year period. We used mixed-effects linear models to determine the association between positive Af culture results, defined as Af detection in sputum culture at the study visit, with both respiratory domain score and forced expiratory volume in 1 second (FEV1) percent predicted, adjusted for confounders. Mixed-effects Poisson regression models were employed to examine the association between positive Af culture results and PEx events. We explored the association between Af history, defined as Af detection at baseline or within 2 years of enrollment, and respiratory outcomes. Results Af prevalence was 10.3% (95% confidence interval [CI], 6.8, 15.7) at baseline. Forty-eight (23.3%...