Many common bacterial infections in children with cystic fibrosis (CF) show seasonal variability and are more prevalent in the winter, a new study shows.
The study, “Seasonality of acquisition of respiratory bacterial pathogens in young children with cystic fibrosis,” was published in the journal BMC Infectious Diseases.
Although seasonal changes are known to be associated with respiratory tract infections, scarce data are available regarding seasonality of respiratory pathogens commonly associated with CF. Such information could be valuable in identifying potential causes for infections and pathogen sources, as well as in improving control strategies for CF-related infections.
The research was led by Kevin J. Psoter with the Department of Pediatrics, School of Medicine, at The Johns Hopkins University Bayview Medical Center, in Baltimore.
The team used the Cystic Fibrosis Foundation National Patient Registry to analyze the seasonal incidence of pathogens resistant to the antibiotic methicillin, and which are often found in samples from CF patients – Staphylococcus aureus (MRSA), Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and Haemophilus influenzae. The researchers evaluated children with CF under age 6 between 2003 to 2009.
The study included a total of 4,552 children. Bacteria infections found during follow-up were H. influenzae in 2,148 (47%) of the children, S. maltophilia in 1161 (26%), MRSA in 910 (20%), and A. xylosoxidans in 228 (5%).
MRSA infections, which are associated with poorer outcomes in CF patients, were less frequent in spring and summer than in the winter. The prevalence of A. xylosoxidans was lower in the spring, and H. influenza infections less frequent during the summer and autumn, compared to winter. No seasonal variation was found for S. maltophilia.
“Acquisition of CF-related respiratory pathogens displays seasonal variation in young children with CF, with the highest rate of acquisition for most pathogens occurring in the winter. Investigation of factors underlying these observed associations may contribute to our understanding of the etiology of these infections and guide future infection control strategies,” the team concluded.
The results, however, contrast with previous data from the same team, which showed that, in the same cohort, infection with Pseudomonas aeruginosa — regarded as the most important CF-related respiratory pathogen and typically acquired from the environment — was more prevalent in the summer and autumn.
The discrepancy may be explained by different sources of infection (including clinic or hospital settings, as well as patient-to-patient transmission), and/or the higher incidence of viral respiratory infections during the winter, which may increase susceptibility to certain bacterial infections in CF patients.
The team emphasizes that future studies should be able to determine the exact date of pathogen acquisition, differentiate between subtypes of bacteria, include older children, and enable analysis of viral infections.
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