The role of geographical location and climate on recurrent Pseudomonas infection in young children with Cystic Fibrosis.

OBJECTIVES: To determine the association between residence and climate with risk of Pseudomonas aeruginosa (Pa) and other respiratory outcomes. METHODS: We performed regular bronchoalveolar lavage and upper airway cultures in young children with CF to identify Pa infection. Children were classified for residence as regional or metropolitan. Bronchiectasis was detected on periodic chest computed tomography scans. Multilocus sequence typing determined Pa genotype. Lung function was assessed using Multiple Breath Washout. RESULTS: Of infants diagnosed with CF between 2006 and 2017, 129 were included in the study. Seven patients moved between metropolitan and regional Victoria and were excluded from analysis. Of the remaining 122 subjects, seventy-four (61%) children resided in metropolitan areas and over half (54%) were male. There were 83 Pa episodes in the 122 children who lived consistently in a geographical location. The incidence rate was 0.15 episodes per person-years. We found weak evidence of a 15% increase in the rate of Pa episodes with increasing average annual maximum temperature (95%CI (0.98, 1.36); p = .086), while the rate of Pa acquision decreased with average annual 3 pm humidity (IRR = 0.96; 95%CI(0.92, 1.0008); p = .054). The rate of Pa episodes was 2.1 times higher in regional participants (95%CI (1.4, 3.1); p = .001) and risk of second episode was more than five times greater (HR 5.7; 95%CI 1.9, 17); p = .002). No difference between regions in lung clearance index and presence of bronchiectasis was detected. CONCLUSION: Regional residence is associated with risk of acquiring recurrent infection with Pseudomonas aeruginosa in young children with CF.

Risk factors for type II endoleaks after endovascular repair of abdominal aortic aneurysms.

BACKGROUND: Endovascular repair has been shown to be superior to open repair of abdominal aortic aneurysm in terms of aneurysm-related survival. However, endovascular repair has its own unique complications such as endoleak. Type II endoleaks may be associated with aortic rupture. We attempt to identify patient variables associated with the development of endoleaks and hence facilitate their early identification. METHODS: Endovascular repair was carried out for non-ruptured, infrarenal abdominal aortic aneurysms. Patients underwent preoperative computed tomography and angiography and were followed up with computed tomography and/or ultrasound scan at 1, 3 and 6 months and yearly thereafter. Univariate and multivariate analysis was used to identify any patient factors associated with the risk for developing an endoleak. RESULTS: One hundred and one patients were included in the study (12 female : 89 male). Age 59-93 years. Mean follow up was 20.2 months. Type II endoleaks developed in 26 (25.7%) patients. Fifteen cases resolved during follow up, three of which required secondary intervention. Nine cases persist. No aneurysms ruptured. The presence of patent inferior mesenteric artery (P < 0.001) and sac enlargement (P = 0.001) were associated with development of endoleak as was diabetes in a multivariate model (P = 0.005). History of smoking (P = 0.01) was a protective factor. The presence of four or more lumbar arteries (P = 0.55) was not associated with increased risk. CONCLUSIONS: It is possible to identify individual patient risk factors associated with risk for developing type II endoleaks and it may be possible to modify screening practice as a result. The association between patent inferior mesenteric artery preoperatively and endoleak is further confirmed. Spontaneous sealing of endoleaks is common and rupture is rare. Early intervention is not mandatory.