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.