Materials and methods
All patients with CF with a first visit at the adult CF center of Lyon
from January 2006 to December 2016 were included if they were previously
followed in the pediatric CF center of Lyon. There were no exclusion
criteria. The follow-up lasted 3 years, starting one year before
transfer until two years after. In both pediatric and adult CF centers,
follow-up and medical care were similar: spirometry (with VC, FEV)
testing and microbiological sputum analysis (sputum were analyzed in the
same bacteriology laboratory using the same microbiological technique of
analysis) every 3 months, inhaled therapy, inhaled or systemic
antibiotics, respiratory physiotherapy, diabetes care, food and vitamin
supplementation, and pancreatic enzyme supplementation. Patients visit
their CF center every 3 months for a medical examination.
The first visit to the adult CF center was defined as the “transition
day” and was named Y0. Its date was defined by pediatricians and
occurred for patients between 17 and 20 years old after obtaining their
agreement in a period of clinical stability. Teams from both centers
(including physicians and paramedics) met for the transition day at the
adult CF center. The same electronic medical files were shared by the
two centers. The transfer process was the same for every patient.
Y-1 was defined as the visit one year before transition day at the
pediatric CF center. Y+1 and Y+2 were the visits one and two years after
transition day, respectively, in the adult CF center. Data were
collected retrospectively from medical files annually throughout the
study period (Y-1, Y0, Y+1, Y+2). The clinical data extracted were age
at transfer, sex, CFTR genotype, respiratory function status (FEV1
liter), and BMI (kg/m2). Microbiological data
concerning chronic pulmonary colonization were extracted:Pseudomonas aeruginosa , Staphylococcus aureus ,Stenotrophomonas maltophilia , Burkholderia cepacia ,
nontuberculous mycobacteria and Aspergillus spp.
Multidrug-resistant Pseudomonas aeruginosa (MRPA) was defined as
a strain of Pseudomonas resistant to at least 3 classes of main
anti-Pseudomonas antibiotics, such as
monobactam/cephalosporins/penicillins, carbapenems, fluoroquinolones or
aminoglycosides. Numbers of intravenous and oral antibiotics courses,
days of hospitalization, and visits at the CF center were also recorded
during the follow-up.