This Article Full Text Full Text (PDF) All Versions of this Article: 200409-1194OCv1 171/9/1020    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Griffiths, A. L. Articles by Armstrong, D. S. Search for Related Content PubMed PubMed Citation Articles by Griffiths, A. L. Articles by Armstrong, D. S.

Effects of Segregation on an Epidemic Pseudomonas aeruginosa Strain in a Cystic Fibrosis Clinic

Department of Respiratory Medicine, Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute; Department of Pediatrics, University of Melbourne, Parkville; Department of Pediatrics, Monash University; Department of Respiratory and Sleep Medicine, Monash Medical Centre, Clayton, Victoria, Australia; and Department of Pediatrics and Child Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

Correspondence and requests for reprints should be addressed to David Armstrong, M.D., Department of Pediatrics, Monash University, Monash Medical Centre, Clayton Road, Clayton, Victoria 3168, Australia. E-mail: david.armstrong{at}southernhealth.org.au

The detection of a clonal Pseudomonas aeruginosa strain in 21% of children attending a cystic fibrosis clinic during 1999, which may have led to a worse prognosis, prompted strict infection control measures, including cohort segregation. We determined whether these strategies interrupted cross-infection within the clinic. Patients from 1999 were observed and a cross-sectional study of the 2002 clinic was performed. By 2002, the epidemic strain prevalence had decreased from 21 to 14% (p = 0.03), whereas the proportion of patients with nonepidemic P. aeruginosa strains was unchanged. The age- and sex-adjusted relative risk for epidemic strains among sputum producers in 2002 compared with 1999 was 0.64 (95% confidence interval, 0.47, 0.87; p = 0.004). Increased mortality or transfer to another clinic did not explain this reduction. Although children with epidemic strains may have had increased mortality (adjusted odds ratio, 2.0; 95% confidence interval, 0.6–6.8), they did not demonstrate greater morbidity than those with other P. aeruginosa isolates. Successful infection control measures provided additional indirect evidence for person-to-person transmission of an epidemic strain within the clinic. Further studies are needed to resolve whether cohort segregation completely eliminates cross-infection and if acquisition of epidemic isolates is associated with worse outcomes.

Key Words: cross-infection • cystic fibrosis • infection control • Pseudomonas aeruginosa

This article has been cited by other articles:

				P. M. Farrell, J. Collins, L. S. Broderick, M. J. Rock, Z. Li, M. R. Kosorok, A. Laxova, W. M. Gershan, and A. S. Brody Association between Mucoid Pseudomonas Infection and Bronchiectasis in Children with Cystic Fibrosis Radiology, August 1, 2009; 252(2): 534 - 543. [Abstract] [Full Text] [PDF]

				T. J. Kidd, K. A. Ramsay, H. Hu, P. T. P. Bye, M. R. Elkins, K. Grimwood, C. Harbour, G. B. Marks, M. D. Nissen, P. J. Robinson, et al. Low Rates of Pseudomonas aeruginosa Misidentification in Isolates from Cystic Fibrosis Patients J. Clin. Microbiol., May 1, 2009; 47(5): 1503 - 1509. [Abstract] [Full Text] [PDF]

				J Abbott Health-related quality of life measurement in cystic fibrosis: advances and limitations Chronic Respiratory Disease, February 1, 2009; 6(1): 31 - 41. [Abstract] [PDF]

				J. Schmid, L. J. Ling, J. L. S. Leung, N. Zhang, J. Kolbe, A. W. Wesley, G. D. Mills, P. J. Brown, D. T. Jones, R. T. R. Laing, et al. Pseudomonas aeruginosa transmission is infrequent in New Zealand cystic fibrosis clinics Eur. Respir. J., December 1, 2008; 32(6): 1583 - 1590. [Abstract] [Full Text] [PDF]

				S. Van daele, M. Vaneechoutte, K. De Boeck, C. Knoop, A. Malfroot, P. Lebecque, J. Leclercq-Foucart, L. Van Schil, K. Desager, and F. De Baets Survey of Pseudomonas aeruginosa genotypes in colonised cystic fibrosis patients Eur. Respir. J., October 1, 2006; 28(4): 740 - 747. [Abstract] [Full Text] [PDF]

				F. J. Accurso Update in cystic fibrosis 2005. Am. J. Respir. Crit. Care Med., May 1, 2006; 173(9): 944 - 947. [Full Text] [PDF]

				Slowing Person-to-Person Spread of Pseudomonas in Cystic Fibrosis Clinics Journal Watch Infectious Diseases, June 10, 2005; 2005(610): 11 - 11. [Full Text]