title: Risk factors for initial acquisition of Pseudomonas aeruginosa in children with cystic fibrosis identified by newborn screening.
abstract: The objective of this study was to identify risk factors for initial detection of Pseudomonas aeruginosa (P. aeruginosa) in children with cystic fibrosis (CF) identified by newborn screening. Life history data on 180 patients, collected prospectively in a follow-up study of infants and children diagnosed with CF, were examined for factors associated with the initial detection of P. aeruginosa ascertained by oropharyngeal cultures. Univariate and multivariate Cox proportional hazards regression analyses were used to assess the effect of baseline and time-varying covariates on age at first positive culture for P. aeruginosa. Seventy-nine patients (44%) had at least one culture positive for P. aeruginosa during the study. The median age of detection was 8.1 years (95% CI, 7.0, 10.0). Median length of follow-up was 4.1 years, ranging from 0.2-15.5 years. Multivariate Cox regression analysis identified female gender (RR, 1.85; 95% CI, 1.14, 3.01), the DeltaF508 homozygous genotype (RR, 2.23; 95% CI, 1.30, 3.80), and S. aureus isolations (RR, 1.30; 95% CI, 1.11, 1.52) to be independently associated with acquisition of P. aeruginosa. Other marginally independent associations were found with days hospitalized and increased height. We conclude that female gender, homozygous DeltaF508 mutation, and S. aureus isolations are important risk factors for early P. aeruginosa detection in children with CF identified through newborn screening.
authors.affiliation: Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado 80218, USA.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Marci K
authors.initials: MK
authors.lastname: Sontag
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
authors.forename: Todd
authors.initials: T
authors.lastname: MacKenzie
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Wagener
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Accurso
mesh_terms: D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D015997:Neonatal Screening; D016016:Proportional Hazards Models; D011552:Pseudomonas Infections / Q000150:complications*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012307:Risk Factors; D012737:Sex Factors