ABSTRACT
BACKGROUND: Although there is now compelling evidence for cross-infection by strains of Pseudomonas aeruginosa at some specialist (cystic fibrosis [CF]) centers, the clinical impact of infection by transmissible strains is unclear. METHODS: In an 8-year prospective study, we compared the clinical outcome of two groups of patients with CF infected by transmissible (n = 28) and sporadic strains (n = 52) of P aeruginosa. RESULTS: There were no differences between the two groups in survival, annual changes in spirometry, or BMI. There were differences in requirements for IV antibiotic treatment (mean [SD]: 29.3 [21.9] days vs 53.1 [32.5] days) and hospitalization (median [range]: 11.6 [1.1, 49.3] days vs 23.3 [5.5, 103.6] days) between patients infected with sporadic and transmissible strains of P aeruginosa, respectively. CONCLUSIONS: We conclude that infection by transmissible P aeruginosa does not increase mortality but is associated with increased health-care and antibiotic use for patients with CF.
Subject(s)
Cross Infection/microbiology , Cystic Fibrosis/microbiology , Pseudomonas Infections/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Chi-Square Distribution , Cross Infection/drug therapy , Cross Infection/epidemiology , Female , Health Resources/statistics & numerical data , Humans , Male , Proportional Hazards Models , Prospective Studies , Pseudomonas Infections/drug therapy , Pseudomonas Infections/epidemiology , Statistics, Nonparametric , Treatment OutcomeABSTRACT
BACKGROUND: This study reviews the impact of changing infection control practices at the Manchester Adult Cystic Fibrosis Centre (MACFC) upon the epidemiology of Burkholderia species infections. METHODS: We reviewed strain and genomovar typing of all available Burkholderia isolates at our centre between 1983-2006. RESULTS: The incidence/prevalence of infection with Burkholderia species between 1983-1990 was below 5%/9% each year. There was a rise in incidence/prevalence of Burkholderia species between 1991 and 1994 with a peak of 16.3%/31.2% in 1992. Following complete cohort segregation, the incidence has fallen to below 3% for all but one year and the prevalence has gradually reduced to 9.3% in 2005. Currently, there is an increase in the prevalence to 10.6% for the first time since 1994, predominantly due to patients with unique infections transferring into the unit from referring centres. The presence of unique strains now exceeds transmissible strains for the first time since 1991. CONCLUSIONS: Infection control measures including patient segregation have controlled spread of transmissible B. cenocepacia strains, but not the acquisition of unique strains. Unique strains of Burkholderia species now account for the majority of new infections at the Manchester Adult Cystic Fibrosis Centre.
Subject(s)
Burkholderia Infections/epidemiology , Burkholderia Infections/microbiology , Burkholderia/isolation & purification , Cystic Fibrosis/complications , Bacterial Typing Techniques , Burkholderia Infections/transmission , Cross Infection/epidemiology , Cross Infection/microbiology , England/epidemiology , Humans , Incidence , Infection Control/methods , Molecular Epidemiology , Prevalence , Prospective Studies , Sputum/microbiologySubject(s)
Cystic Fibrosis/complications , Urinary Incontinence/etiology , Abdominal Muscles/physiopathology , Adolescent , Adult , Child , Cough/etiology , Cough/physiopathology , Cough/therapy , Cystic Fibrosis/physiopathology , Cystic Fibrosis/therapy , Female , Humans , Male , Physical Therapy Modalities , Prevalence , Urinary Incontinence/physiopathology , Urinary Incontinence/therapyABSTRACT
We have performed a 4-year prospective surveillance for Pseudomonas aeruginosa cross-infection at a large regional adult cystic fibrosis center. Despite purpose-built facilities in a new building and the practice of strict hygiene, P. aeruginosa cross-infection has continued. In contrast, individuals segregated from the cohort of patients with chronic P. aeruginosa infection but who attend the same center have not acquired infection with transmissible P. aeruginosa strains. Simple infection control measures alone do not prevent the spread of transmissible P. aeruginosa strains between individuals with cystic fibrosis. However, in our clinic patient segregation effectively controlled spread of such strains.
