This prospective clinical follow-up study is of 106 patients with cystic fibrosis in Copenhagen. Morbidity and mortality in CF are significantly associated with pulmonary colonisation and infection, usually with Gram-negative bacteria. Initially this can be well treated with antibiotics until resistance occurs and there is potentially reinfection from the sinuses. Patients were followed monthly for three years and a large amount of data was collected, such as lower respiratory cultures, spirometry, SNOT-22 and QoL questionnaires. The mean age for surgery was 19 with a range from 6-50 years. Twenty-nine percent underwent revision ESS within the three-year period, median time to revision being 22 months. The number of non-colonised patients doubled over the three-year period, those intermittently colonised decreased and the number chronically infected slightly increased. The cohort tended towards lower rates of positive Gram-negative bacteria in lower airway cultures and in subgroup analyses this was statistically significant in the non-colonised and intermittently colonised groups over three years. There was a decrease in lung function over time and when this was analysed with data from non-ESS patients, no significant difference was found. A non-significant improvement in SNOT-22 scores was found and a decrease in overall QoL over the three years was also found. The study demonstrates that in patients with CF, ESS with adjuvant treatment improves lung infection status, reducing the frequency of Gram-negative lower respiratory culture specimens and potentially stabilises lung function over three years.
Cystic fibrosis – sinus surgery delays chronic Gram-negative lung infection
Review by Suki Ahluwalia
Sinus surgery postpones chronic Gram-negative lung infection: cohort study of 106 patients with cystic fibrosis.
CONTRIBUTOR
Suki Ahluwalia
Cairns Hospital / James Cook University, Queensland, Australia.
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