Preliminary evidence suggests that the CFHealthHub (CFHH) criteria are valid and useful in diagnosing chronic Pseudomonas aeruginosa in adults with cystic fibrosis (CF), according to study results published in Respiratory Medicine.
P aeruginosa is the most prevalent chronic pathogen in adults with CF and is associated with worse prognosis. P aeruginosa status also influences clinical decisions including clinical segregation, the choice of preventive inhaled therapies, and the choice of intravenous antibiotics to treat exacerbations. Although the Leeds criteria is the most commonly used definition for P aeruginosa status in epidemiologic research, clinicians are unlikely to use these criteria in practice.
As a result, researchers developed the CFHH criteria for defining chronic P aeruginosa infection which encompasses several components including results of respiratory samples, anti-Pseudomonas immunoglobulin G antibody levels, variable number tandem repeat typing/genotyping, and clinical context. However, the diagnostic properties of the CFHH criteria have not been tested; therefore, the study authors compared the CFHH criteria against the Leeds criteria in a retrospective cross-sectional analysis of 186 adults with CF (median age, 27 years).
The results demonstrated that the CFHH criteria diagnosed more cases of chronic P aeruginosa (116/186, 62.4% vs 79/186, 42.5%), and 37 of 107 cases of nonchronic P aeruginosa according to the Leeds criteria were deemed chronic P aeruginosa by the CFHH criteria. The magnitude of difference in forced expiratory volume in 1 second percent predicted decline between chronic P aeruginosa vs nonchronic P aeruginosa was slightly greater using the CFHH criteria (-0.6%) compared with the Leeds criteria (-0.2%). In addition, the prescription of long-term inhaled antibiotics better matched the CFHH criteria, with larger differences between patients who were considered nonchronic vs chronic P aeruginosa, compared with the Leeds criteria (-59.7% to -38.5%, respectively)
“The CFHH criteria detected more chronic P aeruginosa cases yet still retained similar levels of discrimination for health outcomes in comparison to the Leeds criteria,” the study authors wrote. “Further evaluation is planned in larger datasets to better understand the diagnostic properties of the CFHH criteria, in particular using the ACtiF dataset (ISRCTN55504164) which is a CF self-management support intervention trial with 608 participants.”
Hoo ZH, Hitchcock L, Curley R, Wildman MJ. A comparison of the CFHH criteria against the Leeds criteria in determining the Pseudomonas aeruginosa status among adults with cystic fibrosis. Respir Med. Published online July 28, 2020. doi:10.1016/j.rmed.2020.106103