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P. aeruginosa identified in patients with cystic fibrosis
Aaron S. JAMA. 2010;304:2145-2153.
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Pseudomonas aeruginosa has been identified in patients with cystic fibrosis in Canada and the United Kingdom and has been associated with a more than two-fold increased risk for death or lung transplantation in this population.
“A transmissable strain of P. aeruginosa, specifically the Liverpool epidemic strain, has crossed the Atlantic Ocean somehow and has infected patients with cystic fibrosis in North America,” Shawn D. Aaron, MD, of the Ottawa Hospital Research Institute, told Infectious Disease News.
For the prospective, observational, cohort study, Aaron and colleagues observed adult patients at cystic fibrosis clinics between 2005 and 2008. Researchers assessed the prevalence and incidence of infection with transmissible strains of P. aeruginosa and if the presence of the organism was associated with adverse clinical outcomes in Canada.
Sputum was collected at baseline, 3 months and yearly for 3 years duration. Researchers genotyped all P. aeruginosa isolates. A lung transplant or death was assessed for all enrolled patients through Dec. 21, 2009.
At baseline, 102 of 446 patients had one of two common transmissible strains of P. aeruginosa. Data indicated that 15% of patients were infected with the P. aeruginosa strain, 7% were infected with strain B, and 0.6% were infected with both strains.
Strain A was genetically identical to the Liverpool epidemic strain. However, strain B has not been previously described as an epidemic strain. According to the researchers, the incidence for new infections was low, 7 per 1,000 person-years.
Further, similar decreases in lung function were observed for patients infected with the Liverpool epidemic strain and strain B. Conversely, the 3-year rate for death or lung transplantation was greater in those infected with the Liverpool epidemic strain when compared with patients infected with unique strains (18.6% vs. 8.7%).
“The most important step would be rigorous infection control, that is, preventing patients with cystic fibrosis from coming into close contact with one another, preventing patients from sharing respiratory equipment such as nebulizers, and keeping them segregated from each other when they come to clinic appointments or when they are admitted to hospital,” Aaron said. – by Ashley DeNyse
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