title: Antibody response to Pseudomonas aeruginosa in cystic fibrosis patients: a marker of therapeutic success?--A 30-year cohort study of survival in Danish CF patients after onset of chronic P. aeruginosa lung infection.
abstract: We studied the effects of increasingly intensive treatment regimens on anti-pseudomonal antibody response and survival in five successive cohorts of a total of 157 Danish cystic fibrosis patients after they had acquired chronic P. aeruginosa lung infection. The time periods were 1971-1975 (N = 21), 1976-1980 (N = 64), 1981-1986 (N = 27), 1987-1993 (N = 26), and 1994-2000 (N = 19). During this 30-year period, we introduced elective 2-week courses of chemotherapy every third month in all chronically infected patients, early aggressive treatment with inhalation of colistin and oral ciprofloxacin for 3 months whenever P. aeruginosa was cultured in sputum from noncolonized patients, and inhalation of recombinant human dornase alfa. There was a significant correlation between the calendar year when chronic P. aeruginosa infection was acquired and the subsequent increase in the level of precipitins (P < 0.00001). The median number of precipitins increased by 5 per year in the oldest calendar year cohort, and 1 per year in the youngest. The median age of onset of chronic P. aeruginosa increased from 9.3 years from 1981-1986 to 13.8 years from 1987-2000. Survival after acquisition of chronic P. aeruginosa lung infection improved with time (P = 0.008). Our study shows that CF patients who are treated intensively have lower antibody responses and longer survival after acquisition of chronic P. aeruginosa lung infection.
authors.affiliation: Department of Clinical Microbiology, H:S Rigshospitalet, Copenhagen, Denmark. h.k.johansen@cochrane.dk
authors.forename: Helle Krogh
authors.initials: HK
authors.lastname: Johansen
authors.forename: Lena
authors.initials: L
authors.lastname: Nørregaard
authors.forename: Peter C
authors.initials: PC
authors.lastname: Gøtzsche
authors.forename: Tacjana
authors.initials: T
authors.lastname: Pressler
authors.forename: Christian
authors.initials: C
authors.lastname: Koch
authors.forename: Niels
authors.initials: N
authors.lastname: Høiby
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000032:analysis*; D002648:Child; D002939:Ciprofloxacin / Q000627:therapeutic use; D015331:Cohort Studies; D003091:Colistin / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D003850:Deoxyribonuclease I / Q000627:therapeutic use; D006801:Humans; D007123:Immunoelectrophoresis, Two-Dimensional; D016014:Linear Models; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000907:Antibodies, Bacterial; D002939:Ciprofloxacin; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I; D003091:Colistin