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Jones AM. Infection control in cystic fibrosis: evolving perspectives and challenges. Curr Opin Pulm Med 2022; 28:571-576. [PMID: 36101908 DOI: 10.1097/mcp.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the impact of some of the most recent changes in clinical care management in cystic fibrosis on infection prevention practice and advice for people with cystic fibrosis. RECENT FINDINGS People with cystic fibrosis (CF) consistently highlight infection control as one of their major concerns. Infection prevention guidance and practice has facilitated successful decreases in rates of many transmissible CF pathogens. The coronavirus disease 2019 pandemic highlighted the clinical significance of respiratory viral infections and has accelerated the implementation of remote monitoring and telemedicine consultations as standard practice in CF. The continued improvement in health of the CF population is being further augmented by the introduction of new therapies, in particular cystic fibrosis transmembrane conductance regulator modulators. Infection prevention will remain pertinent to CF care, but these recent changes in clinical practice will have ongoing implications for infection prevention guidance in CF. SUMMARY Recent changes in CF clinical care have implications that will lead to further evolution of infection control practice and advice.
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Milczewska J, Wołkowicz T, Zacharczuk K, Mierzejewska E, Kwiatkowska M, Walicka-Serzysko K, Sands D. Clinical outcomes for cystic fibrosis patients with Pseudomonas aeruginosa cross-infections. Pediatr Pulmonol 2020; 55:161-168. [PMID: 31556252 DOI: 10.1002/ppul.24535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/16/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Pseudomonas aeruginosa cross-infections are related to increased morbidity and mortality in cystic fibrosis (CF). OBJECTIVES The aim of the study was to evaluate the incidence of cross-infections with P. aeruginosa in children with CF. METHODOLOGY CF patients from whom at least one P. aeruginosa strain had been isolated were included in the study. The strain genotyping was performed using pulse-field gel electrophoresis. The history of contacts between patients was established based on questionnaires. RESULTS The study group consisted of 75 patients (aged 1.0-19.2 years) and the material included 170 P. aeruginosa strains. Cross-infections occurred in a group of 26 patients. In this group, the risk of the predicted occurrence of forced expiratory volume in 1 second ≤ 70% was five times greater and the risk of longer cumulative hospitalization time for intravenous antibiotic therapy (>14 days/year) was almost five times greater. In the clonal groups of strains, the multidrug-resistance rate was significantly higher than in other groups. In 2011, all tested strains were susceptible to colistin, whereas in 2012, three strains from the largest clonal group showed high levels of resistance to colistin. CONCLUSION Cross-infections with P. aeruginosa occurred in our group of patients and were associated with poor clinical outcomes. Antimicrobial resistance rate in the strains isolated from such infections was significantly higher, and this included three strains resistant to colistin.
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Affiliation(s)
- Justyna Milczewska
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Center, Children's Hospital in Dziekanów Leśny, Warsaw, Poland
| | - Tomasz Wołkowicz
- Department of Bacteriology and Biocontamination Control, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Katarzyna Zacharczuk
- Department of Bacteriology and Biocontamination Control, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Monika Kwiatkowska
- Independent Laboratory of Microbiology, Central Laboratory, Institute of Mother and Child, Warsaw, Poland
| | - Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Center, Children's Hospital in Dziekanów Leśny, Warsaw, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.,Cystic Fibrosis Center, Children's Hospital in Dziekanów Leśny, Warsaw, Poland
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3
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Rowbotham NJ, Palser SC, Smith SJ, Smyth AR. Infection prevention and control in cystic fibrosis: a systematic review of interventions. Expert Rev Respir Med 2019; 13:425-434. [DOI: 10.1080/17476348.2019.1595594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nicola J Rowbotham
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Sally C Palser
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Sherie J Smith
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
| | - Alan R Smyth
- Evidence Based Child Health Group, Division of Child Health, Obstetrics & Gynaecology, Queens Medical Centre, Nottingham, UK
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Parkins MD, Somayaji R, Waters VJ. Epidemiology, Biology, and Impact of Clonal Pseudomonas aeruginosa Infections in Cystic Fibrosis. Clin Microbiol Rev 2018; 31:e00019-18. [PMID: 30158299 PMCID: PMC6148191 DOI: 10.1128/cmr.00019-18] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic lower airway infection with Pseudomonas aeruginosa is a major contributor to morbidity and mortality in individuals suffering from the genetic disease cystic fibrosis (CF). Whereas it was long presumed that each patient independently acquired unique strains of P. aeruginosa present in their living environment, multiple studies have since demonstrated that shared strains of P. aeruginosa exist among individuals with CF. Many of these shared strains, often referred to as clonal or epidemic strains, can be transmitted from one CF individual to another, potentially reaching epidemic status. Numerous epidemic P. aeruginosa strains have been described from different parts of the world and are often associated with an antibiotic-resistant phenotype. Importantly, infection with these strains often portends a worse prognosis than for infection with nonclonal strains, including an increased pulmonary exacerbation rate, exaggerated lung function decline, and progression to end-stage lung disease. This review describes the global epidemiology of clonal P. aeruginosa strains in CF and summarizes the current literature regarding the underlying biology and clinical impact of globally important CF clones. Mechanisms associated with patient-to-patient transmission are discussed, and best-evidence practices to prevent infections are highlighted. Preventing new infections with epidemic P. aeruginosa strains is of paramount importance in mitigating CF disease progression.
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Affiliation(s)
- Michael D Parkins
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie J Waters
- Translational Medicine, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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5
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Abstract
Purpose of Review The purpose of this review is to discuss the risk of bacterial cross-infection for bronchiectasis patients in the outpatient setting. Cross-infection has primarily been a matter of concern in cystic fibrosis (CF). There is considerable evidence of transmission of pathogens between CF patients, and this has led to guideline recommendations advocating strict segregation policies. Guidelines in bronchiectasis do not specifically address the issue of cross-infection. If cross-infection is prevalent, it may have significant implications for patients and the practical running of specialist care. Recent Findings Multiple UK-based studies have now published evidence of cross-infection with Pseudomonas aeruginosa within cohorts of bronchiectasis patients; however, the risk does not appear to be high. There is also evidence suggesting cross-infection from CF patients to bronchiectasis patients. Summary The current evidence for cross-infection in bronchiectasis is limited, but suggests a small risk with Pseudomonas aeruginosa. Longitudinal studies looking at Pseudomonas aeruginosa and other pathogens are now required.
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6
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Establishing the diagnosis of chronic colonization with Pseudomonas aeruginosa of cystic fibrosis patients: Comparison of the European consensus criteria with genotyping of P. aeruginosa isolates. J Cyst Fibros 2018; 17:729-735. [PMID: 29655935 DOI: 10.1016/j.jcf.2018.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
Abstract
After antibiotic eradication treatment for a first ever Pseudomonas aeruginosa isolation, the European consensus criteria (ECC) are widely used to assess colonization status with P. aeruginosa in CF-patients. We evaluated to what extent genotyping (GT) of subsequent P. aeruginosa isolates could predict/assess chronic colonization (CC), in comparison with the ECC. METHODS Over a 14-year period, sputa were cultured from 80 CF-patients (age range: 2-51 years), from a first ever isolation of P. aeruginosa onwards. Patients with a positive culture for P. aeruginosa received antibiotic eradication treatment. For the 40 patients for whom three or more P. aeruginosa isolates were available, these isolates were genotyped. RESULTS According to the ECC, 27 out of the 40 patients (67.5%) became CC during the study period (ECC-positive patients). Genotyping confirmed persistence of the same genotype for 25 of these ECC-positive patients. Genotyping indicated persistence of the same genotype for at least two subsequent isolates for 5 out of 13 ECC-negative patients. Culture-positivity characteristics of the 27 ECC-positive patients corresponded well to those of the 30 GT-positive patients, with an overall higher number of positive cultures as well as a shorter interval in between first and second isolate compared to ECC-negative and GT-negative patients. Genotyping indicated persistence of the same genotype on average 9.3 months earlier than CC according to the ECC (P < 0.01). CONCLUSIONS Genotyping of P. aeruginosa isolates confirmed CC for 25 out of 27 ECC-positive patients (92.6% specificity) and predicted CC 9.3 months earlier than the ECC.
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7
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Gilchrist FJ, Jones AM, Smyth AR, Southern KW, Webb AK, Lenney W. Investigating the variation in the incidence of new Pseudomonas aeruginosa infection between paediatric cystic fibrosis centres. J Cyst Fibros 2017; 16:e14-e16. [PMID: 28690130 DOI: 10.1016/j.jcf.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- F J Gilchrist
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke on Trent ST4 6QG, UK; Institute of Applied Clinical Science, Keele University, ST4 7QB, UK.
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - A R Smyth
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham NG7 2UH, UK
| | - K W Southern
- Institute of Child Health, Alder Hey Children's Hospital, Liverpool L12 2AP, UK
| | - A K Webb
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - W Lenney
- Academic Department of Child Health, Royal Stoke University Hospital, Stoke on Trent ST4 6QG, UK; Institute of Applied Clinical Science, Keele University, ST4 7QB, UK
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8
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Bryant JM, Grogono DM, Rodriguez-Rincon D, Everall I, Brown KP, Moreno P, Verma D, Hill E, Drijkoningen J, Gilligan P, Esther CR, Noone PG, Giddings O, Bell SC, Thomson R, Wainwright CE, Coulter C, Pandey S, Wood ME, Stockwell RE, Ramsay KA, Sherrard LJ, Kidd TJ, Jabbour N, Johnson GR, Knibbs LD, Morawska L, Sly PD, Jones A, Bilton D, Laurenson I, Ruddy M, Bourke S, Bowler IC, Chapman SJ, Clayton A, Cullen M, Daniels T, Dempsey O, Denton M, Desai M, Drew RJ, Edenborough F, Evans J, Folb J, Humphrey H, Isalska B, Jensen-Fangel S, Jönsson B, Jones AM, Katzenstein TL, Lillebaek T, MacGregor G, Mayell S, Millar M, Modha D, Nash EF, O'Brien C, O'Brien D, Ohri C, Pao CS, Peckham D, Perrin F, Perry A, Pressler T, Prtak L, Qvist T, Robb A, Rodgers H, Schaffer K, Shafi N, van Ingen J, Walshaw M, Watson D, West N, Whitehouse J, Haworth CS, Harris SR, Ordway D, Parkhill J, Floto RA. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science 2017; 354:751-757. [PMID: 27846606 DOI: 10.1126/science.aaf8156] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Lung infections with Mycobacterium abscessus, a species of multidrug-resistant nontuberculous mycobacteria, are emerging as an important global threat to individuals with cystic fibrosis (CF), in whom M. abscessus accelerates inflammatory lung damage, leading to increased morbidity and mortality. Previously, M. abscessus was thought to be independently acquired by susceptible individuals from the environment. However, using whole-genome analysis of a global collection of clinical isolates, we show that the majority of M. abscessus infections are acquired through transmission, potentially via fomites and aerosols, of recently emerged dominant circulating clones that have spread globally. We demonstrate that these clones are associated with worse clinical outcomes, show increased virulence in cell-based and mouse infection models, and thus represent an urgent international infection challenge.
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Affiliation(s)
- Josephine M Bryant
- Wellcome Trust Sanger Institute, Hinxton, UK.,University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | - Dorothy M Grogono
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Daniela Rodriguez-Rincon
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | | | - Karen P Brown
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Pablo Moreno
- EMBL European Bioinformatics Institute, Hinxton, UK
| | - Deepshikha Verma
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | - Emily Hill
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | - Judith Drijkoningen
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | - Peter Gilligan
- University of North Carolina School of Medicine, NC, USA
| | | | - Peadar G Noone
- University of North Carolina School of Medicine, NC, USA
| | | | - Scott C Bell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia.,The Prince Charles Hospital, Brisbane, Australia
| | - Rachel Thomson
- Gallipoli Medical Research Centre, University of Queensland, Brisbane, Australia
| | - Claire E Wainwright
- School of Medicine, The University of Queensland, Australia.,Lady Cilento Children's Hospital, Brisbane
| | - Chris Coulter
- Queensland Mycobacterial Reference Laboratory, Brisbane, Australia
| | - Sushil Pandey
- Queensland Mycobacterial Reference Laboratory, Brisbane, Australia
| | - Michelle E Wood
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia.,The Prince Charles Hospital, Brisbane, Australia
| | - Rebecca E Stockwell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia
| | - Kay A Ramsay
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia
| | | | - Timothy J Kidd
- Centre for Experimental Medicine, Queen's University Belfast, UK.,School of Chemistry and Biomolecular sciences, The University of Queensland, Australia
| | - Nassib Jabbour
- Queensland University of Technology, Brisbane, Australia.,International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Andrew Jones
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Diana Bilton
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | | | | | - Stephen Bourke
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | | | - Mairi Cullen
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Thomas Daniels
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Owen Dempsey
- Aberdeen Royal Infirmary, NHS Grampian, Scotland, UK
| | | | - Maya Desai
- Birmingham Children's Hospital NHS Foundation Trust, UK
| | | | | | | | - Jonathan Folb
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Helen Humphrey
- University Hospital Southampton NHS Foundation Trust, UK
| | - Barbara Isalska
- University Hospital of South Manchester NHS Foundation Trust, UK
| | | | - Bodil Jönsson
- Department of Infectious Medicine, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Andrew M Jones
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Terese L Katzenstein
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Troels Lillebaek
- International reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Gordon MacGregor
- Gartnavel Hospital, Glasgow, NHS Greater Glasgow and Clyde, Scotland, UK
| | | | | | | | - Edward F Nash
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | | | - Audrey Perry
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Tania Pressler
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Laura Prtak
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Tavs Qvist
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ali Robb
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | - Nadia Shafi
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martin Walshaw
- Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
| | | | - Noreen West
- Sheffield Children's NHS Foundation Trust, UK
| | | | - Charles S Haworth
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | | | - Diane Ordway
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | | | - R Andres Floto
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
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The Effect of Strict Segregation on Pseudomonas aeruginosa in Cystic Fibrosis Patients. PLoS One 2016; 11:e0157189. [PMID: 27280467 PMCID: PMC4900627 DOI: 10.1371/journal.pone.0157189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/25/2016] [Indexed: 01/20/2023] Open
Abstract
Introduction Segregation of patients with cystic fibrosis (CF) was implemented to prevent chronic infection with epidemic Pseudomonas aeruginosa strains with presumed detrimental clinical effects, but its effectiveness has not been carefully evaluated. Methods The effect of strict segregation on the incidence of P. aeruginosa infection in CF patients was investigated through longitudinal protocolized follow-up of respiratory tract infection before and after segregation. In two nested cross-sectional studies in 2007 and 2011 the P. aeruginosa population structure was investigated and clinical parameters were determined in patients with and without infection with the Dutch epidemic P. aeruginosa clone (ST406). Results Of 784 included patients 315 and 382 were at risk for acquiring chronic P. aeruginosa infection before and after segregation. Acquisition rates were, respectively, 0.14 and 0.05 per 1,000 days at risk (HR: 0.66, 95% CI [0.2548–1.541]; p = 0.28). An exploratory subgroup analysis indicated lower acquisition after segregation in children < 15 years of age (HR: 0.43, 95% CI[0.21–0.95]; p = 0.04). P. aeruginosa population structure did not change after segregation and ST406 was not associated with lung function decline, death or lung transplantation. Conclusions Strict segregation was not associated with a statistically significant lower acquisition of chronic P. aeruginosa infection and ST406 was not associated with adverse clinical outcome. After segregation there were no new acquisitions of ST406. In an unplanned exploratory analysis chronic acquisition of P. aeruginosa was lower after implementation of segregation in patients under 15 years of age.
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Saiman L, Siegel JD, LiPuma JJ, Brown RF, Bryson EA, Chambers MJ, Downer VS, Fliege J, Hazle LA, Jain M, Marshall BC, O’Malley C, Pattee SR, Potter-Bynoe G, Reid S, Robinson KA, Sabadosa KA, Schmidt HJ, Tullis E, Webber J, Weber DJ. Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 1:S1-S67. [DOI: 10.1086/676882] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1.The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2.Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistantStaphylococcus aureus(MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.
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11
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Infection control knowledge, beliefs and behaviours amongst cystic fibrosis patients with epidemic Pseudomonas aeruginosa. BMC Pulm Med 2015; 15:138. [PMID: 26542115 PMCID: PMC4635525 DOI: 10.1186/s12890-015-0116-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023] Open
Abstract
Background Epidemic P. aeruginosa (ePA) infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline. Factors associated with ePA are unclear, and evidence based infection control interventions are lacking. Methods We prospectively collect all bacterial pathogens from adult CF patients. We performed PA strain typing on retrospectively collected enrolment samples and recent isolates to identify patients infected with ePA. All patients attending our clinic were approached to complete a survey on infection control knowledge, beliefs and exposures. We analyzed responses of those with ePA relative to the entire cohort without ePA as well as those infected with unique strains of P. aeruginosa to assess for risk factors for ePA and differences in infection control knowledge, beliefs or behaviours. Results Of 144 participants, 30 patients had ePA (two Liverpool epidemic strain, 28 Prairie epidemic strain), 83 % of which had established infection prior to transition to the adult clinic. Risk of concomitant infecting pathogens was no different between groups although, Staphylococcus aureus and non-tuberculous mycobacteria were less common in those with ePA. Patients with ePA were more likely to have attended CF-camp and have a history of CF fundraising. Patients with ePA did not differ with respect to beliefs regarding pathogens or transmission risk, except they believed indirect contact posed little risk. Furthermore, patients with ePA were more likely to continue to associate with others with CF despite extensive counselling. Use of peer-peer online networking was minimal in both groups. Conclusion Infections with ePA are closely linked to past exposures, now routinely discouraged. As socialization is the greatest risk factor for ePA, infection control strategies for ePA must focus on discouraging face-to-face interactions amongst CF patients. As peer support remains a desire amongst patients, investment in technologies and strategies that enable indirect communication and support are required.
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12
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Ferreira AG, Leão RS, Carvalho-Assef APD, da Silva ÉADSR, Firmida MDC, Folescu TW, Paixão VA, Santana MA, de Abreu e Silva FA, Barth AL, Marques EA. Low-level resistance and clonal diversity of Pseudomonas aeruginosa among chronically colonized cystic fibrosis patients. APMIS 2015; 123:1061-8. [PMID: 26522829 DOI: 10.1111/apm.12463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/18/2015] [Indexed: 02/02/2023]
Abstract
A prospective study was conducted in Brazil to evaluate antimicrobial resistance patterns and molecular epidemiology of Pseudomonas aeruginosa isolates from cystic fibrosis (CF) patients with chronic lung infection. All isolates were obtained between May 2009 and June 2010 from 75 patients seen in four reference centers in Brazil: HCPA (20 patients) and HEOM (15 patients), located in southern and northeastern Brazil, respectively; IFF (20 patients) and HUPE (20 patients), both in southwestern Brazil. Antimicrobial susceptibility testing, PCR for detection of carpapenemases, and pulsed-field gel electrophoresis (PFGE) were performed in 274 isolates. A total of 224 PFGE types were identified and no clones were found circulating among the centers or within the same center. Despite the chronic infection, most patients were colonized by intermittent clones. Only three patients (4%) maintained the same clone during the study. The resistance rates were lower than 30% for the majority of antimicrobials tested in all centers and only 17% of isolates were multiresistant. Isolates (n = 54) with reduced susceptibility to imipenem and/or meropenem presented negative results for blaSPM-1, blaIMP-1, blaVIM , and blaKPC genes. Our results indicate an unexpected low level of antimicrobial resistance and a high genotypic diversity among P. aeruginosa from Brazilian chronic CF patients.
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Affiliation(s)
- Alex Guerra Ferreira
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 87, fundos, Rio de Janeiro, RJ, Brazil
| | - Robson Souza Leão
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 87, fundos, Rio de Janeiro, RJ, Brazil
| | | | | | - Monica de Cássia Firmida
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tania Wrobel Folescu
- Instituto Fernandes Figueira, Fundação Instituto Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Vilma Almeida Paixão
- Serviço de Pneumologia, Hospital Especializado Octávio Mangabeira, Salvador, BA, Brazil
| | | | | | - Afonso Luís Barth
- Laboratório de Pesquisa em Resistência Bacteriana - Centro de Pesquisas Experimental Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elizabeth Andrade Marques
- Disciplina de Microbiologia e Imunologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 87, fundos, Rio de Janeiro, RJ, Brazil
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13
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Association of meteorological and geographical factors and risk of initial Pseudomonas aeruginosa acquisition in young children with cystic fibrosis. Epidemiol Infect 2015; 144:1075-83. [PMID: 26449886 DOI: 10.1017/s0950268815002411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Initial infection with the sentinel respiratory pathogen in children with cystic fibrosis (CF), Pseudomonas aeruginosa (Pa), is generally with environmental strains of this ubiquitous organism. The purpose of this study was to evaluate the associations between meteorological and geographical factors and risk of initial Pa acquisition in young children with CF. Using the U.S. Cystic Fibrosis Foundation Patient Registry from 2003 to 2009, 3463 patients met inclusion criteria, of which 48% (n = 1659) acquired Pa during follow-up. From multivariable Weibull regression, increased risk of Pa acquisition was associated with increasing temperature [hazard ratio (HR) per 1 °C: 1·13; 95% confidence interval (CI) 1·08-1·13], dew point (HR per 1 °C: 1·10, 95% CI 1·07-1·13), rainfall (HR per cm: 1·10, 95% CI 1·07-1·12), latitude (HR per 1 °C northing: 1·15, 95% CI 1·11-1·20), longitude (HR per 1 °C easting: 1·01, 95% CI 1·01-1·02) and elevation (HR per 100 m: 1·05, 95% CI 1·03-1·07). These results suggest that environmental factors may play a previously unrecognized role in the aetiology of initial Pa acquisition.
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Tolker-Nielsen T. Pseudomonas aeruginosa biofilm infections: from molecular biofilm biology to new treatment possibilities. APMIS 2015:1-51. [PMID: 25399808 DOI: 10.1111/apm.12335] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bacteria in natural, industrial and clinical settings predominantly live in biofilms, i.e., sessile structured microbial communities encased in self-produced extracellular matrix material. One of the most important characteristics of microbial biofilms is that the resident bacteria display a remarkable increased tolerance toward antimicrobial attack. Biofilms formed by opportunistic pathogenic bacteria are involved in devastating persistent medical device-associated infections, and chronic infections in individuals who are immune-compromised or otherwise impaired in the host defense. Because the use of conventional antimicrobial compounds in many cases cannot eradicate biofilms, there is an urgent need to develop alternative measures to combat biofilm infections. The present review is focussed on the important opportunistic pathogen and biofilm model organism Pseudomonas aeruginosa. Initially, biofilm infections where P. aeruginosa plays an important role are described. Subsequently, current insights into the molecular mechanisms involved in P. aeruginosa biofilm formation and the associated antimicrobial tolerance are reviewed. And finally, based on our knowledge about molecular biofilm biology, a number of therapeutic strategies for combat of P. aeruginosa biofilm infections are presented.
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Affiliation(s)
- Tim Tolker-Nielsen
- Costerton Biofilm Center, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Knibbs LD, Johnson GR, Kidd TJ, Cheney J, Grimwood K, Kattenbelt JA, O'Rourke PK, Ramsay KA, Sly PD, Wainwright CE, Wood ME, Morawska L, Bell SC. Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis. Thorax 2014; 69:740-5. [PMID: 24743559 PMCID: PMC4112489 DOI: 10.1136/thoraxjnl-2014-205213] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Person-to-person transmission of respiratory pathogens, including Pseudomonas aeruginosa, is a challenge facing many cystic fibrosis (CF) centres. Viable P aeruginosa are contained in aerosols produced during coughing, raising the possibility of airborne transmission. Methods Using purpose-built equipment, we measured viable P aeruginosa in cough aerosols at 1, 2 and 4 m from the subject (distance) and after allowing aerosols to age for 5, 15 and 45 min in a slowly rotating drum to minimise gravitational settling and inertial impaction (duration). Aerosol particles were captured and sized employing an Anderson Impactor and cultured using conventional microbiology. Sputum was also cultured and lung function and respiratory muscle strength measured. Results Nineteen patients with CF, mean age 25.8 (SD 9.2) years, chronically infected with P aeruginosa, and 10 healthy controls, 26.5 (8.7) years, participated. Viable P aeruginosa were detected in cough aerosols from all patients with CF, but not from controls; travelling 4 m in 17/18 (94%) and persisting for 45 min in 14/18 (78%) of the CF group. Marked inter-subject heterogeneity of P aeruginosa aerosol colony counts was seen and correlated strongly (r=0.73–0.90) with sputum bacterial loads. Modelling decay of viable P aeruginosa in a clinic room suggested that at the recommended ventilation rate of two air changes per hour almost 50 min were required for 90% to be removed after an infected patient left the room. Conclusions Viable P aeruginosa in cough aerosols travel further and last longer than recognised previously, providing additional evidence of airborne transmission between patients with CF.
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Affiliation(s)
- Luke D Knibbs
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Timothy J Kidd
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Joyce Cheney
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Jacqueline A Kattenbelt
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Peter K O'Rourke
- QIMR/RBWH Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Kay A Ramsay
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia
| | - Claire E Wainwright
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Queensland Children's Respiratory Centre, Royal Children's Hospital, Herston, Queensland, Australia
| | - Michelle E Wood
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Scott C Bell
- Queensland Children's Medical Research Institute, The University of Queensland, Herston, Queensland, Australia Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
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Clifton IJ, Peckham DG. Defining routes of airborne transmission ofPseudomonas aeruginosain people with cystic fibrosis. Expert Rev Respir Med 2014; 4:519-29. [DOI: 10.1586/ers.10.42] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Conway SP, Lee TW. Prevention of chronic Pseudomonas aeruginosa infection in people with cystic fibrosis. Expert Rev Respir Med 2012; 3:349-61. [PMID: 20477327 DOI: 10.1586/ers.09.26] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cystic fibrosis is the most common genetically inherited disease in the Caucasian population, with approximately 30,000 patients in the USA and more than 50,000 patients worldwide. The primary defect in the cystic fibrosis transmembrane regulator gene affects the production and/or function of the cystic fibrosis transmembrane regulator protein. Depending on the severity of the genetic defect, patients may have minimal disease expression (e.g., male infertility) or multisystem involvement, including recurrent respiratory infection progressing to respiratory failure, hepatobiliary disease, exocrine pancreatic insufficiency, diabetes mellitus and gastrointestinal tract motility problems. Pseudomonas aeruginosa is commonly isolated from the lower respiratory tract in early childhood. Chronic infection is associated with increased morbidity and mortality. P. aeruginosa infection may be acquired from the environment or by person-to-person contact. Clinicians should adopt a proactive protocol to prevent chronic infection. The cornerstones of such a policy are microbiological surveillance, infection control and antibiotic-based eradication regimens.
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Affiliation(s)
- Steven P Conway
- CF Services, Leeds Regional Paediatric Cystic Fibrosis Centre, Childrens' Day Hospital, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Pseudomonas aeruginosa exhibits frequent recombination, but only a limited association between genotype and ecological setting. PLoS One 2012; 7:e44199. [PMID: 22970178 PMCID: PMC3435406 DOI: 10.1371/journal.pone.0044199] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/30/2012] [Indexed: 01/12/2023] Open
Abstract
Pseudomonas aeruginosa is an opportunistic pathogen and an important cause of infection, particularly amongst cystic fibrosis (CF) patients. While specific strains capable of patient-to-patient transmission are known, many infections appear to be caused by unique and unrelated strains. There is a need to understand the relationship between strains capable of colonising the CF lung and the broader set of P. aeruginosa isolates found in natural environments. Here we report the results of a multilocus sequence typing (MLST)-based study designed to understand the genetic diversity and population structure of an extensive regional sample of P. aeruginosa isolates from South East Queensland, Australia. The analysis is based on 501 P. aeruginosa isolates obtained from environmental, animal and human (CF and non-CF) sources with particular emphasis on isolates from the Lower Brisbane River and isolates from CF patients obtained from the same geographical region. Overall, MLST identified 274 different sequence types, of which 53 were shared between one or more ecological settings. Our analysis revealed a limited association between genotype and environment and evidence of frequent recombination. We also found that genetic diversity of P. aeruginosa in Queensland, Australia was indistinguishable from that of the global P. aeruginosa population. Several CF strains were encountered frequently in multiple ecological settings; however, the most frequently encountered CF strains were confined to CF patients. Overall, our data confirm a non-clonal epidemic structure and indicate that most CF strains are a random sample of the broader P. aeruginosa population. The increased abundance of some CF strains in different geographical regions is a likely product of chance colonisation events followed by adaptation to the CF lung and horizontal transmission among patients.
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19
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Greally P, Whitaker P, Peckham D. Challenges with current inhaled treatments for chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis. Curr Med Res Opin 2012; 28:1059-67. [PMID: 22401602 DOI: 10.1185/03007995.2012.674500] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Pa) is the predominant pathogen infecting the airways of patients with cystic fibrosis (CF). Initial colonization is usually transient and associated with non-mucoid strains, which can be eradicated if identified early. This strategy can prevent, or at least delay, chronic Pa infection, which eventually develops in the majority of patients by their late teens or early adulthood. This article discusses the management and latest treatment developments of Pa lung infection in patients with CF, with a focus on nebulized antibiotic therapy. METHODS PubMed was searched to identify English language articles published up until August 2011 using combinations of the following key words: 'antibiotics', 'chronic', 'cystic fibrosis', 'eradication', 'exacerbations', 'guidelines', 'inhaled', 'intravenous', 'lung infection', 'burden', 'adherence', 'patient segregation', 'pseudomonas aeruginosa' and 'resistance'. FINDINGS Antibiotics form a central part of the treatment regimens for chronic Pa lung infection. Current treatment guidelines recommend that patients with chronic pulmonary infection with Pa should receive long-term inhaled anti-pseudomonal therapy to preserve lung function, and to reduce the frequency of pulmonary exacerbations and hospital admissions. While antibiotic resistance seems to increase with frequent antibiotic use, this does not appear to impact on clinical outcome. Negative aspects of therapy include the time needed for drug administration and subsequent cleaning of the equipment. These factors cause a significant treatment burden and impact on adherence. The availability of more convenient formulations and delivery vehicles for anti-pseudomonal antibiotics may help overcome some of these challenges. CONCLUSIONS Current challenges in the management of CF patients with chronic Pa lung infection are numerous. The availability of novel anti-pseudomonal antibiotic formulations/devices is anticipated to improve treatment adherence in patients with CF, and could improve clinical outcomes. Thus, there is hope for improved survival in individuals with CF suffering from chronic pulmonary infection with Pa.
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Affiliation(s)
- Peter Greally
- National Children's Hospital, Tallaght, Dublin, Ireland.
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Wiehlmann L, Cramer N, Ulrich J, Hedtfeld S, Weißbrodt H, Tümmler B. Effective prevention of Pseudomonas aeruginosa cross-infection at a cystic fibrosis centre – Results of a 10-year prospective study. Int J Med Microbiol 2012; 302:69-77. [DOI: 10.1016/j.ijmm.2011.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/04/2011] [Accepted: 11/06/2011] [Indexed: 11/28/2022] Open
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21
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Cohen-Cymberknoh M, Shoseyov D, Kerem E. Managing cystic fibrosis: strategies that increase life expectancy and improve quality of life. Am J Respir Crit Care Med 2011; 183:1463-71. [PMID: 21330455 DOI: 10.1164/rccm.201009-1478ci] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The survival of patients with cystic fibrosis (CF) continues to improve. The discovery and cloning of the CFTR gene more than 21 years ago led to the identification of the structure and function of the CFTR chloride channel. New therapies based on the understanding of the function of CFTR are currently under development. The better clinical status and improved survival of patients with CF is not only a result of understanding of the molecular mechanisms of CF but also a result of the development of therapeutic strategies that are based on insights into the natural course of the disease. Current CF treatments that target respiratory infections, inflammation, mucociliary clearance, and nutritional status are associated with improved pulmonary function and reduced exacerbations. Patients benefit from treatment at a specialized CF center by a multidisciplinary dedicated team with emphasis being placed on frequent visits, periodic testing, and monitoring adherence to therapy. The purpose of this review is to survey recent developments in CF care that are responsible for the improved survival and quality of life of patients with CF.
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Affiliation(s)
- Malena Cohen-Cymberknoh
- Department of Pediatrics and CF Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Hauser AR, Jain M, Bar-Meir M, McColley SA. Clinical significance of microbial infection and adaptation in cystic fibrosis. Clin Microbiol Rev 2011; 24:29-70. [PMID: 21233507 PMCID: PMC3021203 DOI: 10.1128/cmr.00036-10] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
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Affiliation(s)
- Alan R Hauser
- Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611, USA.
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23
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Hayes D, West SE, Rock MJ, Li Z, Splaingard ML, Farrell PM. Pseudomonas aeruginosa in children with cystic fibrosis diagnosed through newborn screening: assessment of clinic exposures and microbial genotypes. Pediatr Pulmonol 2010; 45:708-16. [PMID: 20575089 PMCID: PMC2921980 DOI: 10.1002/ppul.21263] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic pulmonary infection with Pseudomonas aeruginosa (PA) is responsible for significant morbidity and mortality in cystic fibrosis (CF). Because of the limited studies evaluating early exposure and the progression of genetic variability of PA, our goal was to assess PA in young children with CF followed in two clinic types. METHODS A total of 39 infants with CF diagnosed through newborn screening were randomly assigned to either a segregated (PA-free) or mixed (PA-positive) clinic at two different CF centers, one of which replaced an older, mixed clinic where nosocomial acquisition was suspected. Oropharyngeal (OP) swab cultures were examined with subsequent genotyping to characterize the strains of PA isolated. RESULTS We found that 13/21 segregated clinic patients and 14/18 mixed clinic patients showed positive PA, with median acquisition ages of 3.3 and 2.2 years, respectively (P = 0.57). The median time to PA acquisition, however, was significantly longer in the new clinic with proper hygiene precautions compared to an old site (5.0 years vs. 1.7 years, P < 0.001). The majority of subjects isolated a single genotype of PA or AP-PCR types during the study period with eight subjects clearing the isolate after only one positive culture. The development of chronic colonization yielded the predominance of a single major genotype or AP-PCR type. CONCLUSIONS Segregation of infants and young children with CF in PA-negative or PA-positive clinics did not alter the time to first PA isolation in this randomized assessment of facilities with hygienic precautions. During the early infection period where PA is first isolated in young children with CF, patients cleared different PA strains until a predominant strain established permanent colonization.
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Affiliation(s)
- Don Hayes
- Department of Pediatrics and Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
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24
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TINGPEJ P, ELKINS M, ROSE B, HU H, MORIARTY C, MANOS J, BARRAS B, BYE P, HARBOUR C. Clinical profile of adult cystic fibrosis patients with frequent epidemic clones of Pseudomonas aeruginosa. Respirology 2010; 15:923-9. [DOI: 10.1111/j.1440-1843.2010.01792.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Jones AM, Dodd ME, Morris J, Doherty C, Govan JR, Webb AK. Clinical Outcome for Cystic Fibrosis Patients Infected With Transmissible Pseudomonas aeruginosa : An 8-Year Prospective Study. Chest 2010; 137:1405-9. [DOI: 10.1378/chest.09-2406] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Schelstraete P, Deschaght P, Van Simaey L, Van daele S, Haerynck F, Vaneechoutte M, De Baets F. Genotype based evaluation of Pseudomonas aeruginosa eradication treatment success in cystic fibrosis patients. J Cyst Fibros 2010; 9:99-103. [DOI: 10.1016/j.jcf.2009.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 11/20/2009] [Accepted: 11/23/2009] [Indexed: 10/20/2022]
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27
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McKay KO, Cooper PJ, van Asperen PP. Segregation of children with CF diagnosed via newborn screening and acquisition of Pseudomonas aeruginosa. J Cyst Fibros 2009; 8:400-4. [DOI: 10.1016/j.jcf.2009.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/21/2009] [Accepted: 07/26/2009] [Indexed: 10/20/2022]
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Pseudomonas aeruginosa genotype prevalence in Dutch cystic fibrosis patients and age dependency of colonization by various P. aeruginosa sequence types. J Clin Microbiol 2009; 47:4096-101. [PMID: 19828746 DOI: 10.1128/jcm.01462-09] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The patient-to-patient transmission of highly prevalent Pseudomonas aeruginosa clones which are associated with enhanced disease progression has led to strict segregation policies for cystic fibrosis (CF) patients in many countries. However, little is known about the population structure of P. aeruginosa among CF patients. The aim of the present cross-sectional study was to determine the prevalence and genetic relatedness of P. aeruginosa isolates from CF patients who visited two major CF centers in The Netherlands in 2007 and 2008. These patients represented 45% of the Dutch CF population. P. aeruginosa carriage in the respiratory tract was determined by standard microbiological culture techniques, and all phenotypically different isolates in the first specimens recovered in 2007 and 2008 were genotyped by multilocus sequence typing. A total of 313 (57%) of 551 patients whose samples were cultured carried P. aeruginosa. Two sequence types (STs), ST406 and ST497, were found in 15% and 5% of the patients, respectively, and 60% of the patients harbored a strain that was also found in at least two other patients. The risk ratios for carrying ST406 and ST497 were 17.8 (95% confidence interval [CI], 7.2 to 43.6) for those aged between 15 and 24 years and 6 (95% CI, 1.4 to 26.1) for those aged >25 years. ST406 and ST497 were not genetically linked to previously described epidemic clones, which were also not found in this CF population. The population structure of P. aeruginosa in Dutch CF patients is characterized by the presence of two prevalent STs that are associated with certain age groups and that are not genetically linked to previously described epidemic clones.
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Knudsen PK, Olesen HV, Høiby N, Johannesson M, Karpati F, Laerum BN, Meyer P, Pressler T, Lindblad A. Differences in prevalence and treatment of Pseudomonas aeruginosa in cystic fibrosis centres in Denmark, Norway and Sweden. J Cyst Fibros 2009; 8:135-42. [PMID: 19157995 DOI: 10.1016/j.jcf.2008.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 08/27/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chronic Pseudomonas aeruginosa (PA) infection causes increased morbidity and mortality in cystic fibrosis (CF). This study aimed to answer the following questions: Does the prevalence of chronic infection with PA differ between the CF centres in Scandinavia? Which differences exist concerning segregation and treatment of PA? METHODS 989 patients (86%) from all eight CF-centres in Scandinavia were included. Demographic and clinical data, including PA colonisation status based on cultures and serology, were recorded at inclusion. The patients were followed prospectively for 1 year, recording number of days with anti-PA antibiotic treatment. RESULTS In all pancreatic insufficient (PI) patients (n=890) the prevalence of chronic PA infection at each centre ranged from 25.8% to 48.9%, but were not significantly different. In PI patients <19 years the prevalence was 14.5% in Copenhagen compared to 30.9% in the Swedish centres pooled (p=0.001). In intermittently colonised PI patients <19 years the median number of days per year on anti-PA antibiotics was almost 6 times higher in Copenhagen (mean 86 (110), median 61 days) compared to the Swedish centres pooled (mean 27 (52), median 11 days) (p=0.037). The pulmonary function was similar. CONCLUSIONS It is possible to maintain a very low prevalence of chronic PA infection in CF patients <19 years. We speculate that this was most likely due to a very intensive treatment of intermittently colonised patients with inhaled anti-PA antibiotics over prolonged periods of time in some centres. Since lung function was similar in centres with less intensive use of inhaled antibiotics, studies comparing different treatment modalities and other parts of CF care are needed to define the best clinical practice, including how to use antibiotics in the most rational way.
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Affiliation(s)
- Per Kristian Knudsen
- National Center for Cystic Fibrosis, Ullevaal University Hospital, Oslo, Norway.
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30
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Affiliation(s)
- Duncan Geddes
- Royal Brompton Hospital Sydney Street, London SW3 6NP, UK.
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31
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Affiliation(s)
- Steven Conway
- Regional Paediatric and Adult Cystic Fibrosis Centres, Childrens' Day Hospital, St James' University Hospital Beckett Street, Leeds LS9 7TF, UK.
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Zhou J, Garber E, Saiman L. Survey of infection control policies for patients with cystic fibrosis in the United States. Am J Infect Control 2008; 36:220-2. [PMID: 18371519 DOI: 10.1016/j.ajic.2007.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/29/2007] [Accepted: 05/31/2007] [Indexed: 11/29/2022]
Abstract
Written infection control policies used at cystic fibrosis (CF) care sites in the United States were compared with recently published guidelines. Most policies recommended contact precautions for hospitalized patients infected with Burkholderia cepacia complex (73%), multidrug-resistant organisms (63%), and methicillin-resistant Staphylococcus aureus (64%). Socializing among CF patients was discouraged in 80% of inpatient policies and 55% of outpatient policies. Although routine mask use by patients remains an unresolved issue, many policies advocated this practice. Future studies should address barriers to implementation of these evidence-based guidelines and continue to monitor implementation.
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Affiliation(s)
- Juyan Zhou
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
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Abstract
In this article, the authors outline some of the major historical events that signaled the need to better understand mechanisms of infection in cystic fibrosis (CF). The authors discuss general principles of infection control, focusing on issues of particular importance to patients who have CF. The authors also describe the major pathogens associated with the CF airway, provide a review of findings from inpatient and outpatient studies of infection control, and provide an outline of future directions for investigation.
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Affiliation(s)
- Jonathan B Zuckerman
- Department of Medicine, The University of Vermont College of Medicine, E-126 Given Building, 89 Beaumont Avenue, Burlington, VT 05405-0068, USA.
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Abstract
PURPOSE OF REVIEW Over the past four decades, outcomes for patients with cystic fibrosis have improved dramatically. Major contributors to this improvement are a better understanding of disease pathogenesis and the systematic conduct of clinical trials evaluating new therapies designed to address these defects. This review describes recent developments in cystic fibrosis pulmonary therapies intended to treat various facets of the disease, including several treatments currently in development. RECENT FINDINGS The mainstays of therapy for cystic fibrosis, such as nutritional support and mechanical mucus clearance, are now supplemented with aggressive antibiotic regimens intended to suppress or eradicate bacterial colonization, anti-inflammatory agents, and new approaches that improve mucociliary clearance. Therapies in development address the underlying ion transport defect found in cystic fibrosis airways and also include small-molecule agents that restore function to the mutant cystic fibrosis transmembrane conductance regulator. SUMMARY Recent advances in therapies for cystic fibrosis offer the promise of improved outcomes and longer lives for patients with cystic fibrosis.
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Affiliation(s)
- Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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35
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van Ewijk BE, Wolfs TFW, Fleer A, Kimpen JLL, van der Ent CK. High Pseudomonas aeruginosa acquisition rate in CF. Thorax 2006; 61:641-2. [PMID: 16807394 PMCID: PMC2104671 DOI: 10.1136/thx.2006.062372] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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36
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Affiliation(s)
- Frank J Accurso
- Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218, USA.
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37
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Kappler M, Kraxner A, Reinhardt D, Ganster B, Griese M, Lang T. Diagnostic and prognostic value of serum antibodies against Pseudomonas aeruginosa in cystic fibrosis. Thorax 2006; 61:684-8. [PMID: 16449259 PMCID: PMC2104684 DOI: 10.1136/thx.2005.049536] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Eradication of Pseudomonas aeruginosa in patients with cystic fibrosis (CF) is possible if initiated early in the course of colonisation. To detect P aeruginosa as early as possible is therefore a major goal. This study was undertaken to validate a commercialised test for the detection of serum Pseudomonas antibodies in patients with CF. METHODS A representative cross sectional analysis of serum antibodies against three Pseudomonas antigens (alkaline protease, elastase, and exotoxin A) was performed in 183 patients with CF of mean age 16.7 years and FEV1 85.9% predicted. The results were correlated with microbiological results from the previous 2 years to calculate sensitivity, specificity, positive and negative predictive values. The following 2 years were assessed to determine prognostic predictive values. RESULTS A combination of all three tested antibodies yielded the best results with a sensitivity of 86%, specificity of 96%, and a positive predictive value of 97%. These values were higher if only patients in whom sputum cultures were available were considered (n = 76, sensitivity 95%, specificity 100%, positive predictive value 100%). The prognostic positive predictive value was high in intermittently infected patients (83%) but low in patients free of infection (33%), whereas the prognostic negative predictive value was high in patients free of infection (78%) and low in intermittently infected patients (58%). CONCLUSIONS Regular determination of serum antibodies may be useful in CF patients with negative or intermittent but not with positive P aeruginosa status. A rise in antibody titres indicates probable infection and eradication treatment may be initiated even in the absence of microbiological detection of P aeruginosa.
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Affiliation(s)
- M Kappler
- Children's University Hospital of the Ludwig-Maxmilians-University, Munich, Germany
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Jones AM, Dodd ME, Govan JRW, Doherty CJ, Smith CM, Isalska BJ, Webb AK. Prospective Surveillance forPseudomonas aeruginosaCross-Infection at a Cystic Fibrosis Center. Am J Respir Crit Care Med 2005; 171:257-60. [PMID: 15542795 DOI: 10.1164/rccm.200404-513oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Andrew M Jones
- Adult Cystic Fibrosis Centre, Department of Medical Microbiology, Wythenshawe Hospital, South Manchester University Hospitals NHS Trust, Southmoor Road, Manchester M23 9LT, UK.
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