Two research letters in this week’s issue of THE LANCET provide new evidence that patients with cystic fibrosis (CF) are susceptible to cross-infection-including superinfection-to the bacterium Pseudomonas aeruginosa.
Chronic colonisation with P aeruginosa occurs in up to 80% of adults with CF, and is associated with increased illness and death. Once a patient with CF acquires a P aeruginosa strain, it has been thought to be unusual for them to acquire a different strain. Martin Walshaw and colleagues from the Regional Adult Cystic Fibrosis Unit, Liverpool, UK, investigated genotypic changes in strains of P aeruginosa in adult patients in their CF clinic. Four adults with CF acquired a new strain (AH), probably as a result of social contact in hospital with patients colonised with the AH strain. The investigators suggest that inpatients with CF who are colonised with P aeruginosa should be separated by strain type, although they acknowledge that this approach (which involves genotyping) has resource implications.
In a second research letter, Andrew Jones and colleagues from the Adult Cystic Fibrosis Centre, Manchester, and Edinburgh University Medical School,UK, did a surveillance study and found that 14% of patients in the Manchester adult clinic had a multiresistant strain which differed from the Liverpool outbreak. The investigators recommend microbiological surveillance in other CF centres.
In an accompanying Commentary (p 522), Duncan Geddes from the Royal Brompton National Heart and Lung Hospital, London, UK, discusses the measures that have been proposed for infection control in CF clinics. He cautions: “Perhaps the most worrying feature of the debate is the effect on the families with CF. There is a real risk of stigmatisation by sputum bacteriology, enhanced anxiety about what may be a relatively benign organism (many adults with CF remain well despite positive cultures of Pseudomonas aeruginosa for decades), and fear of attending a CF centre or any school or social event where another person with CF may be met. There are risks in doing too little but it may be worse to do too much.”
Contact: Dr Martin J Walshaw, Regional Adult Cystic Fibrosis Unit, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK; T) 44-151-228-1616 x2390; F) 44-151-293-2331; E) Martin.Walshaw@CCL-TR.NWEST.NHS.UK
Dr Andrew M Jones, Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Southmoor Road ,Manchester M23 9LT, UK; T) 44-161-795-4567 bleep 4104; F) 44-161-291-2080; E) andmarkj@hotmail.com
Journal
The Lancet