Association of Otitis and/or Rhinosinusitis and Pseudomonas Aeruginosa in Sputum of Patients With Non-cystic Fibrosis Bronchiectasis

Abstract Rationale: Pseudomonas aeruginosa (PsA) airway infection is associated with increased symptom burden and worse prognosis in patients with non-cystic fibrosis bronchiectasis (NCFB). Once airway PsA infection develops, eradicating it is challenging. Paranasal sinuses are a niche for PsA and a source of lower airway re-infection in patients with cystic fibrosis. Both Rhinosinusitis and PsA are common in NCFB, but whether there is an association between them is unknown. Methods: NCFB patients in the US Bronchiectasis and NTM Research Registry (BRR) with physician reported “otitis and/or rhinosinusitis” (ORS) and known bacterial culture results at enrollment were included. Patients with and without ORS were compared with respect to demographic and clinical characteristics using Kruskal Wallis, independent t-test and chi square tests, as applicable. A multivariable logistic regression was used to model the relationship between ORS and PsA in sputum. Results: Of the 3140 NCFB patients who met the inclusion criteria, 13.9% had a known history of ORS. Compared with the non-ORS group, ORS patients were younger (median 68.0 vs. 70.0 yrs., p<0.001), less often female (74.1% vs. 81.1%, p<0.001), more likely to have asthma (41.8% vs 21.9%), primary ciliary dyskinesia (4.6% vs. 1.0%, p<0.001), ≥1 exacerbation or pulmonary illness requiring hospitalization in the preceding 2 years (24.2% vs. 17.5%, p<0.001) or to have received inhaled antibiotics (12.4% vs. 8.6%, p=0.011). Among the 1358/3140 patients with complete data availability for all adjusted variables, 27.2% had ≥1 PsA-positive sputum. History of ORS positively correlated with PsA in sputum (OR: 1.57, 95% CI: 1.14 to 2.18) after adjusting for age, BMI, sex, smoking history, asthma, FEV1 % predicted, exacerbations, hospitalizations, dyspnea, number of lobes involved, chronic macrolide treatment, and immunocompromised status (Figure 1). In the same 1358 patients, history of hospitalization for bronchiectasis exacerbation (OR 1.37; 95% CI 1.02 to 1.80) and greater number of lobes involved (OR 1.14; 95% CI 1.07 to 1.21) were also associated with PsA culture positivity, while smoking history (OR 0.66; 95% CI 0.51 to 0.86) and higher FEV1 % predicted (OR for each percent increase: 0.98, 95% CI: 0.98 to 0.99) were associated with a decreased odds of PsA. Conclusions: We found a significant association between physician-reported history of ORS and PsA in sputum culture among NCFB patients at the time of enrollment in the US BRR. Future studies should address whether treatment of rhinosinusitis can reduce PsA airway infection burden and improve NCFB disease severity and prognosis.