title: Association of meteorological and geographical factors and risk of initial Pseudomonas aeruginosa acquisition in young children with cystic fibrosis.
abstract: Initial infection with the sentinel respiratory pathogen in children with cystic fibrosis (CF), Pseudomonas aeruginosa (Pa), is generally with environmental strains of this ubiquitous organism. The purpose of this study was to evaluate the associations between meteorological and geographical factors and risk of initial Pa acquisition in young children with CF. Using the U.S. Cystic Fibrosis Foundation Patient Registry from 2003 to 2009, 3463 patients met inclusion criteria, of which 48% (n = 1659) acquired Pa during follow-up. From multivariable Weibull regression, increased risk of Pa acquisition was associated with increasing temperature [hazard ratio (HR) per 1 °C: 1·13; 95% confidence interval (CI) 1·08-1·13], dew point (HR per 1 °C: 1·10, 95% CI 1·07-1·13), rainfall (HR per cm: 1·10, 95% CI 1·07-1·12), latitude (HR per 1 °C northing: 1·15, 95% CI 1·11-1·20), longitude (HR per 1 °C easting: 1·01, 95% CI 1·01-1·02) and elevation (HR per 100 m: 1·05, 95% CI 1·03-1·07). These results suggest that environmental factors may play a previously unrecognized role in the aetiology of initial Pa acquisition.
authors.affiliation: Department of Biostatistics,Johns Hopkins Bloomberg School of Public Health,Baltimore,MD,USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Psoter
authors.affiliation: Department of Environmental and Occupational Health,Drexel University School of Public Health,Philadelphia,PA,USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: DE Roos
authors.affiliation: Departments of Statistics and Biostatistics,University of Washington,Seattle,WA,USA.
authors.forename: J
authors.initials: J
authors.lastname: Wakefield
authors.affiliation: Departments of Epidemiology,Geography,Global Health,Medicine (Allergy and Infectious Diseases),Family Medicine, and Health Services,University of Washington,Seattle,WA,USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Mayer
authors.affiliation: Department of Epidemiology and Biostatistics,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA,USA.
authors.forename: M
authors.initials: M
authors.lastname: Bryan
authors.affiliation: Division of Pulmonary Medicine,University of Washington School of Medicine,Seattle,WA,USA.
authors.forename: M
authors.initials: M
authors.lastname: Rosenfeld
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003550:Cystic Fibrosis / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016016:Proportional Hazards Models; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014887:Weather
keywords: Cystic fibrosis; Pseudomonas; epidemiology; paediatrics; respiratory infections