Published ahead of print on February 11, 2005, doi:10.1164/rccm.200409-1194OC Am. J. Respir. Crit. Care Med., Volume 171, Number 9, May 2005, 1020-1025 A more recent version of this article appeared on May 1, 2005
Submitted on September 13, 2004 Effects of Segregation Upon an Epidemic Pseudomonas aeruginosa Strain in a Cystic Fibrosis ClinicAmanda L Griffiths1,1 Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia, 2 Department of Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia, 3 Department of Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia, 4 Department of Paediatrics and Child Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, Wellington, New Zealand, 5 Department of Paediatrics, Respiratory and Sleep Medicine, Monash University and Monash Medical Centre, Clayton, Victoria, Australia * To whom correspondence should be addressed. E-mail: david.armstrong{at}southernhealth.org.au.
Detection of a clonal Pseudomonas aeruginosa strain in 21% of children attending a cystic fibrosis clinic during 1999 that 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 followed and a cross-sectional study of the 2002 clinic performed. By 2002 the epidemic strain prevalence had decreased from 21% to 14% (p=.03), while the proportion of patients with non-epidemic P. aeruginosa strains was unchanged. The age and gender 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=.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 to 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: Cystic fibrosis, cross-infection, infection control, Pseudomonas aeruginosa
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