P170 Bacterial and fungal co-colonisation leads to poorer clinical outcomes in an adult cystic fibrosis population

Abstract

Objective: Aspergillus fumigatus (AF) is the most common fungal pathogen isolated from CF sputum, with an increasing prevalence. The clinical importance of colonisation with other fungi such as Scedosporium apiospermum (SA) or Exophiala dermatitidis remains uncertain. Here we compared clinical outcomes of people with CF colonised with fungi. Methods: Electronic care records for 269 adults with CF were reviewed. Clinical outcomes including ppFEV1, weight, pulmonary exacerbations (PEx) and IV antibiotic days were compared in patients colonised with common fungal pathogens and those who were not. Results: Patients colonised with AF (n = 27) were significantly younger than those without [28.7(7.5) vs 35.6(14.3) years; p = 0.02] with lower mean(SD) weight [58.7(12.0) vs 68.2(15.1) kg; p = 0.001] and ppFEV1 [58.4 (22.0) vs 70.1(25.3); p = 0.02], with significantly more PEx and IV days [40.0 (51.4) vs 13.6(28.3) days; p = 0.02]. Patients co-colonised with AF and Pseudomonas aeruginosa (PA) had a trend towards lower ppFEV1, weight and higher serum AF IgG levels than those with chronic PA alone (all p > 0.05). Patients co-colonised with chronic PA and AF had significantly more IV days than those with chronic PA alone. Patients colonised with SA (n = 5) required significantly more IV days [50.2(36.8) vs 15.5(31.4); p = 0.02] and more admissions [4.2(3.1) vs 1.24(2.2) p = 0.004] than those who were not. Weight and ppFEV1 were also lower although not significantly. Conclusion: Here we report significantly poorer clinical outcomes for patients with CF colonised with fungal pathogens particularly those co-colonised with AF and PA. It remains unclear whether the mechanism of pathogenicity is direct or indirect. Future studies are required to standardise use of more sensitive culture techniques to isolate fungi in respiratory tract samples and to delineate the role of fungi in CF airway infections.