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Previous issue date: 2017-03-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: Cystic fibrosis is an autosomal recessive genetic disorder characterized mainly by obstruction and inflammation of the airways leading to the chronic establishment of microorganisms. Acute infections (exacerbations) and/or chronic colonization lead to a progressive decline in lung function that leads to respiratory failure, the main cause of death among these individuals. Despite advances in survival, aspects related to infections still need to be reviewed. Thus, the main objective of the study was to evaluate the impact of different bacterial colonizations on nutritional status, lung function and clinical severity in patients with cystic fibrosis (CF).
Methods: This is a retrospective cohort study that included patients with a confirmed diagnosis of CF, aged > 3 years and presenting complete data in a reference database of cystic fibrosis and / or available medical records. Anthropometric information (weight and height for the purpose of calculating BMI) and nutritional status, clinical severity data, colonization of airway secretions in addition to lung function (FEV1, FVC and FEV1/FVC). All the data collected were the annual evaluation of these subjects, between the period from 2009 to 2013. For statistical purposes, the Friedman test (Dunn's post-test) and the Mann Whitney U test were used.
Results: We included 68 patients with CF out of a total of 80 who are regularly followed by the service, with 57.4% being male with a mean age of 10.35 years at baseline. During the five-year follow-up (mean of 3.55 years), nutritional status (p = 0.743) and clinical severity score (p = 0.235) remained stable. There was a statistically significant reduction of FEV1/FVC ratio over the follow-up (from year 2 to year 3 and year 2 to year 5; p <0.05). The most frequent colonizations were oxacillin-sensitive Staphylococcus aureus (MSSA) (29.8-46.3%), followed by non-mucoid Pseudomonas aeruginosa (PA) (8.5-19.4%), Burkholderia Cepacia Complex CBC) (4.9-21.3%), mucoid PA (2,4-6,5 %) and oxacilina/meticilin-resistent Staphylococcus aureus (MRSA) (2,4- 16,1%). Patients who were colonized throughout the study by MRSA (p = 0.040) had a reduction in FEV1 (p = 0.004) and FVC (p = 0.005) in year 5 compared to those not colonized by this bacteria. In addition, individuals with non-mucoid BP had a reduction (p = 0.007) in FVC.
Conclusions: Our findings demonstrate that bacterial colonization by oxacilina/meticilin-resistent Staphylococcus aureus and non-mucoid Pseudomonas aeruginosa is related to worsening lung function (FEV1 and FVC). However, the impact of the different colonizations on BMI and on the clinical severity of Shwachman-Kulczycki score over the 5 years was not observed.
Key words: Microbiology, nutritional status, respiratory function tests, prognosis, cystic fibrosis. / Introdu??o: A fibrose c?stica ? uma doen?a gen?tica autoss?mica recessiva, caracterizada principalmente por obstru??o e inflama??o das vias a?reas que leva a instala??o cr?nica de microrganismos. As infec??es agudas e/ou coloniza??es cr?nicas levam a um progressivo decl?nio da fun??o pulmonar que evolui para fal?ncia respirat?ria, principal causa de morte entre estes indiv?duos. Apesar dos avan?os alcan?ados na sobrevida, aspectos relacionados a infec??es ainda necessitam ser revisados. Assim, o objetivo principal do estudo foi avaliar o impacto de diferentes coloniza??es bacterianas sobre o estado nutricional, fun??o pulmonar e gravidade cl?nica em pacientes com fibrose c?stica (FC).
M?todos: Trata-se de um estudo de coorte, retrospectivo onde foram inclu?dos pacientes com diagn?stico confirmado de FC, com idade > 3anos e que apresentassem os dados completos em um banco de dados de um servi?o de refer?ncia em fibrose c?stica e/ou dispon?veis nos prontu?rios m?dicos. Foram coletadas informa??es antropom?tricas (peso e estatura para fins de c?lculo de IMC) e verifica??o do estado nutricional, dados cl?nicos de gravidade, coloniza??es presentes nas secre??es das vias a?reas al?m da fun??o pulmonar (VEF1, CVF e VEF1/ CVF). Todos os dados coletados se tratavam da avalia??o anual desses sujeitos, entre o per?odo de 2009 a 2013. Para fins estat?sticos, utilizou-se o teste de Friedman (p?s-teste de Dunn?s) e o teste U de Mann Whitney.
Resultados: Foram inclu?dos 68 pacientes com FC de um total de 80 que s?o acompanhados regularmente pelo servi?o, sendo 57,4 % do sexo masculino com idade m?dia de 10,35 anos no in?cio do estudo. Ao longo do seguimento de cinco anos (m?dia de 3,55 anos) o estado nutricional (p=0,743) e o escore de gravidade cl?nica (p=0,235) permaneceram est?veis. Houve uma redu??o estatisticamente significativa da rela??o VEF1/CVF ao longo do acompanhamento (do ano 2 para o ano 3 e do ano 2 para o ano 5; p<0,05). As coloniza??es mais frequentes foram a Staphylococcus aureus sens?vel a Oxacilina (MSSA) (29,8-46,3%), seguidas da Pseudomonas aeruginosa (PA) n?o muc?ide (8,5-19,4%), Complexo Burkholderia Cepacia (CBC) (4,9-21,3%), PA mucoide (2,4-6,5 %) e Staphylococcus aureus resistente a oxacilina (2,4- 16,1%). Os pacientes que foram colonizados ao longo do estudo por MRSA (p=0,040) apresentaram uma redu??o do VEF1 (p=0,004) e da CVF (p=0,005) no ano 5, em compara??o aos n?o colonizados por essa bact?ria. Al?m disso, os indiv?duos com PA n?o mucoide apresentaram redu??o (p=0,007) da CVF.
Conclus?es: Nossos achados demonstram que a coloniza??o bacteriana por Staphylococcus aureus resistente a oxacilina e por Pseudomonas aeruginosa n?o muc?ide est? relacionada a piora na fun??o pulmonar (VEF1 e CVF). Todavia, n?o foi observado impacto das diferentes coloniza??es sobre o IMC e sobre o escore de gravidade cl?nica de Shwachman-Kulczycki ao longo dos 5 anos.
Palavras-chave: Microbiologia, estado nutricional, testes de fun??o respirat?ria, progn?stico, fibrose c?stica.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7630 |
| Date | 31 March 2017 |
| Creators | Valad?o, Maria Clara da Silva |
| Contributors | Pinto, Leonardo Ara?jo |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3098206005268432148, 500, 500, 500, 600, -224747486637135387, -969369452308786627, 2075167498588264571 |
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