Respiratory Infections and Antibiotic Usage in Common Variable Immunodeficiency.

Abstract

BACKGROUND:

Patients with common variable immunodeficiency (CVID) suffer frequent respiratory tract infections despite immunoglobulin replacement and are prescribed significant quantities of antibiotics. The clinical and microbiological nature of these exacerbations, the symptomatic triggers to take antibiotics, and the response to treatment have not been previously investigated.

OBJECTIVES:

To describe the nature, frequency, treatment, and clinical course of respiratory tract exacerbations in patients with CVID and to describe pathogens isolated during respiratory tract exacerbations.

METHODS:

We performed a prospective diary card exercise in 69 patients with CVID recruited from a primary immunodeficiency clinic in the United Kingdom, generating 6210 days of symptom data. We collected microbiology (sputum microscopy and culture, atypical bacterial PCR, and mycobacterial culture) and virology (nasopharyngeal swab multiplex PCR) samples from symptomatic patients with CVID.

RESULTS:

There were 170 symptomatic exacerbations and 76 exacerbations treated by antibiotics. The strongest symptomatic predictors for commencing antibiotics were cough, shortness of breath, and purulent sputum. There was a median delay of 5 days from the onset of symptoms to commencing antibiotics. Episodes characterized by purulent sputum responded more quickly to antibiotics, whereas sore throat and upper respiratory tract symptoms responded less quickly. A pathogenic virus was isolated in 56% of respiratory exacerbations and a potentially pathogenic bacteria in 33%.

CONCLUSIONS:

Patients with CVID delay and avoid treatment of symptomatic respiratory exacerbations, which could result in structural lung damage. However, viruses are commonly represented and illnesses dominated by upper respiratory tract symptoms respond poorly to antibiotics, suggesting that antibiotic usage could be better targeted.

• Authors: Johannes M Sperlich, Bodo Grimbacher, Sarita Workman, Tanzina Haque, Suranjith L Seneviratne, Siobhan O Burns, Veronika Reiser, Werner Vach, John R Hurst, David M Lowe
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) 2018 Jan - Feb Vol. 6 Issue 1 Pg. 159-168.e3 ISSN: 2213-2201 [Electronic] United States
• PMID: 28734862 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bacterial Infections (diagnosis, drug therapy, epidemiology)
• Cohort Studies
• Common Variable Immunodeficiency (drug therapy, epidemiology)
• Drug Utilization
• Female
• Humans
• Male
• Middle Aged
• Nasopharynx (virology)
• Polymerase Chain Reaction
• Prospective Studies
• Respiratory Tract Infections (diagnosis, drug therapy, epidemiology)
• Sputum (microbiology)
• United Kingdom (epidemiology)
• Virus Diseases (diagnosis, drug therapy, epidemiology)