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Semin Respir Crit Care Med 2003; 24(6): 703-716
DOI: 10.1055/s-2004-815666
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Patient Cohorting and Infection Control

Christian Koch1 , Birgitte Frederiksen1 , Niels Høiby2
  • 1Department of Pediatrics, East-Danish Cystic Fibrosis Centre
  • 2Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Denmark
Further Information

Publication History

Publication Date:
15 January 2004 (online)

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ABSTRACT

Patients with cystic fibrosis (CF) have an abnormal propensity for recurrent and chronic infections of the lower respiratory tract (LRT), and the most common cause of a shortened lifespan is chronic infection with Pseudomonas aeruginosa. A few other gram-negative organisms, primarily Burkholderia cepacia complex have, however, emerged as serious pathogens capable of establishing chronic LRT infection. Details of these and other CF pathogens can be found in the article by Dr. John LiPuma, Burkholderia and Emerging Pathogens in Cystic Fibrosis, in this issue. Chronically infected patients constitute a major microbial reservoir from which noninfected patients can be infected with both P. aeruginosa and B. cepacia complex by direct patient-to-patient transmission, and possibly also by exposure to contaminated environments. Other more rare pathogens such as Stenotrophomonas maltophilia, Achromobacter xylosoxidans, and nontuberculous mycobacteria (NTM) appear less capable of causing patient-to-patient transmission. Both the physical proximity and the duration of exposure of noninfected patients to patients chronically infected with P. aeruginosa and B. cepacia complex are important determinants of the risk of cross-infection. Cohorting of patients according to presence or absence of specific pathogens coupled with conventional hygienic precautions can, however, lead to a decrease in incidence and prevalence of chronic infections with these two species, wherefore patient cohorting is now an integral component of infection control in patients with CF.

KEYWORDS

Cystic fibrosis - patient cohorting - infection control

REFERENCES

  • 1 Høiby N, Frederiksen B. Microbiology of cystic fibrosis. In: Hodson ME, Geddes D, eds. Cystic Fibrosis London: Arnold 2000 : 83-108
    Search in Google Scholar
  • 2 Rajan S, Saiman L. Pulmonary infections in patients with cystic fibrosis.  Semin Respir Infect . 2002;  17 47-56
    PubMedSearch in Google Scholar
  • 3 Von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia.  N Engl J Med . 2001;  344 11-16
    CrossrefPubMedSearch in Google Scholar
  • 4 Goerke C, Kraning K, Stern M, Döring G, Botzenhart K, Wolz C. Molecular epidemiology of community-acquired Staphylococcus aureus in families with and without cystic fibrosis patients.  J Infect Dis . 2000;  181 984-989
    CrossrefPubMedSearch in Google Scholar
  • 5 Branger C, Gardye C, Lambert-Zechovsky N. Persistence of Staphylococcus aureus strains among cystic fibrosis patients over extended periods of time.  J Med Microbiol . 1996;  45 294-301
    PubMedSearch in Google Scholar
  • 6 Di Sant'Agnese A P, Andersen D A. Celiac syndrome: chemotherapy in infections of the respiratory tract associated with cystic fibrosis of the pancreas: observations with penicillin and drugs of the sulfonamide group, with special reference to penicillin aerosol.  Am J Dis Child . 1946;  72 17-61
    PubMedSearch in Google Scholar
  • 7 Høiby N, Friis B, Jensen K. et al . Antimicrobial chemotherapy in cystic fibrosis patients.  Acta Paediatr Scand . 1982;  suppl 301 33-54
    PubMedSearch in Google Scholar
  • 8 Burns D R, Emerson J, Stapp J R. et al . Microbiology of sputum from patients at cystic fibrosis centers in the United States.  Clin Infect Dis . 1998;  27 158-163
    CrossrefPubMedSearch in Google Scholar
  • 9 Givney R, Vickery A, Holliday A, Pegler M, Benn R. Methicillin-resistant Staphylococcus aureus in a cystic fibrosis unit.  J Hosp Infect . 1997;  35 27-36
    CrossrefPubMedSearch in Google Scholar
  • 10 Thomas S R, Gyi K M, Gaya H, Hodson M E. Methicillin-resistant Staphylococcus aureus: impact at a national cystic fibrosis centre.  J Hosp Infect . 1998;  40 203-209
    CrossrefPubMedSearch in Google Scholar
  • 11 Miall L S, McGinley N T, Brownlee K G, Conway S P. Methicillin resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis.  Arch Dis Child . 2001;  84 160-162
    CrossrefPubMedSearch in Google Scholar
  • 12 Schlichting C, Branger C, Fournier J-M. et al . Typing of Staphylococcus aureus by pulsed field gel electrophoresis, zymotyping, capsular typing, and phage typing: resolution of clonal relationships.  J Clin Microbiol . 1993;  31 227-232
    PubMedSearch in Google Scholar
  • 13 Bell S M. Recommendations for control of the spread of methicillin-resistant Staphylococcus aureus infection based on 18 years' experience in a group of teaching hospitals.  Med J Aust . 1982;  1 472-474
    PubMedSearch in Google Scholar
  • 14 Cystic Fibrosis Foundation. Patient Registry 2000 Annual Report. Bethesda, MD: September 2001
  • 15 Konstan M W, Hilliard K A, Norvell T M, Berger M. Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation.  Am J Respir Crit Care Med . 1994;  150 448-454
    PubMedSearch in Google Scholar
  • 16 Armstrong D S, Grimwood K, Carlin J B. et al . Lower airway inflammation in infants and young children with cystic fibrosis.  Am J Respir Crit Care Med . 1997;  156 1197-1204
    PubMedSearch in Google Scholar
  • 17 Burns J L, Gibson R L, McNamara S. et al . Longitudinal assessment of Pseudomonas aeruginosa in young children with cystic fibrosis.  J Infect Dis . 2001;  183 444-452
    CrossrefPubMedSearch in Google Scholar
  • 18 Dakin C L, Numa A H, Wang H, Morton J R, Vertzyas C C, Henry R L. Inflammation, infection, and pulmonary function in infants and young children with cystic fibrosis.  Am J Respir Crit Care Med . 2002;  165 904-910
    CrossrefPubMedSearch in Google Scholar
  • 19 Govan J RW, Nelson J W. Microbiology of lung infection in cystic fibrosis.  Br Med Bull . 1992;  48 912-930
    PubMedSearch in Google Scholar
  • 20 Döring G, Jansen S, Noll J. et al . Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward.  Pediatr Pulmonol . 1996;  21 90-100
    CrossrefPubMedSearch in Google Scholar
  • 21 Zimakoff J, Høiby N, Rosendal K, Guilbert J P. Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic.  J Hosp Infect . 1983;  4 31-40
    CrossrefPubMedSearch in Google Scholar
  • 22 Speert D P, Campbell M E. Hospital epidemiology of Pseudomonas aeruginosa from patients with cystic fibrosis.  J Hosp Infect . 1987;  9 11-21
    CrossrefPubMedSearch in Google Scholar
  • 23 Wolz C, Kiosz G, Ogle J W. et al . Pseudomonas aeruginosa cross-colonization and persistence in patients with cystic fibrosis: use of a DNA probe.  Epidemiol Infect . 1989;  102 205-214
    PubMedSearch in Google Scholar
  • 24 Govan J RW, Glass S. The microbiology and therapy of cystic fibrosis lung infections.  Rev Med Microbiol . 1990;  1 19-28
    PubMedSearch in Google Scholar
  • 25 Botzenhart K, Döring G. Epidemiology and ecology of Pseudomonas aeruginosa In: Campa M, Bendinelli M, Friedman H, eds. Pseudomonas aeruginosa as an Opportunistic Pathogen.  New York: Plenum 1993: 1-18
    Search in Google Scholar
  • 26 Döring G, Ulrich M, Müller W. et al . Generation of Pseudomonas aeruginosa aerosols during handwashing from contaminated sink drains, transmission to hands of hospital personnel, and its prevention by use of a new heating device.  Zentralbl Hyg Umweltmed . 1991;  191 494-505
    PubMedSearch in Google Scholar
  • 27 Pitchford K C, Corey M, Highsmith A K. et al . Pseudomonas species contamination of cystic fibrosis patients' home inhalation equipment.  J Pediatr . 1987;  111 212-216
    PubMedSearch in Google Scholar
  • 28 Rosenfeld M, Emerson J, Astley S. et al . Home nebulizer use among patients with cystic fibrosis.  J Pediatr . 1998;  132 125-131
    PubMedSearch in Google Scholar
  • 29 Jensen E T, Giwercman B, Ojeniyi B. et al . Epidemiology of Pseudomonas aeruginosa in cystic fibrosis and the possible role of contamination by dental equipment.  J Hosp Infect . 1997;  36 117-122
    CrossrefPubMedSearch in Google Scholar
  • 30 Kelly N M, Fitzgerald M X, Tempany E, O'Boyle C, Falkiner F R, Keane C T. Does Pseudomonas cross-infection occur between cystic-fibrosis patients?.  Lancet . 1982;  ii 688-689
    PubMedSearch in Google Scholar
  • 31 Thomassen M J, Demko C A, Doershuk C F, Rood J M. Pseudomonas aeruginosa isolates: comparison of isolates from campers and from sibling pairs with cystic fibrosis.  Pediatr Pulmonol . 1985;  1 40-45
    PubMedSearch in Google Scholar
  • 32 Tümmler B, Koopmann U, Grothues D, Weissbrodt H, Steinkamp G, von der Hardt H. Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients.  J Clin Microbiol . 1991;  29 1265-1267
    PubMedSearch in Google Scholar
  • 33 Renders N HM, Sijmons M AF, van Belkum A, Overbeek S E, Mouton J W, Verbrugh H A. Exchange of Pseudomonas aeruginosa strains among cystic fibrosis siblings.  Res Microbiol . 1997;  148 447-454
    CrossrefPubMedSearch in Google Scholar
  • 34 Grothues D, Koopmann U, von der Hardt H, Tümmler B. Genome fingerprinting of Pseudomonas aeruginosa indicates colonization of cystic fibrosis siblings with closely related strains.  J Clin Microbiol . 1988;  26 1973-1977
    PubMedSearch in Google Scholar
  • 35 Kosorok M R, Jalaluddin M, Farrell P M. et al . Comprehensive analysis of risk factors for acquisition of Pseudomonas aeruginosa in young children with cystic fibrosis.  Pediatr Pulmonol . 1998;  26 81-88
    CrossrefPubMedSearch in Google Scholar
  • 36 Ojeniyi B, Petersen U S, Høiby N. Comparison of genome fingerprinting with conventional typing methods used on Pseudomonas aeruginosa isolates from cystic fibrosis patients.  APMIS . 1993;  101 168-175
    PubMedSearch in Google Scholar
  • 37 Ojeniyi B, Frederiksen B, Høiby N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp.  Pediatr Pulmonol . 2000;  29 177-181
    CrossrefPubMedSearch in Google Scholar
  • 38 Fluge G, Ojeniyi B, Høiby N. et al . Typing of Pseudomonas aeruginosa strains in Norwegian cystic fibrosis patients.  Clin Microbiol Infect . 2001;  7 238-243
    CrossrefPubMedSearch in Google Scholar
  • 39 Speert D P, Campbell M E, Henry D A. et al . Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada.  Am J Respir Crit Care Med . 2002;  166 988-993
    CrossrefPubMedSearch in Google Scholar
  • 40 Römling U, Fiedler B, Bosshammer J. et al . Epidemiology of chronic Pseudomonas aeruginosa infections in cystic fibrosis.  J Infect Dis . 1994;  170 1616-1621
    PubMedSearch in Google Scholar
  • 41 Martin C, Boyd E F, Quentin R, Massicot P, Selander R K. Enzyme polymorphism in Pseudomonas aeruginosa strains recovered from cystic fibrosis patients in France.  Microbiology . 1999;  145 2587-2594
    PubMedSearch in Google Scholar
  • 42 Jones A M, Govan J RW, Doherty C J. et al . Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic.  Lancet . 2001;  358 557-558
    CrossrefPubMedSearch in Google Scholar
  • 43 McCallum S J, Corkill J, Gallagher M, Ledson M J, Hart C A, Walshaw M J. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa .  Lancet . 2001;  358 558-560
    CrossrefPubMedSearch in Google Scholar
  • 44 Armstrong D S, Nixon G M, Carzino R. et al . Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic.  Am J Respir Crit Care Med . 2002;  166 983-987
    CrossrefPubMedSearch in Google Scholar
  • 45 Cheng K, Smyth R L, Govan J R. et al . Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic.  Lancet . 1996;  348 639-642
    CrossrefPubMedSearch in Google Scholar
  • 46 Pedersen S S, Koch C, Høiby N, Rosendal K. An epidemic spread of multiresistant Pseudomonas aeruginosa in a cystic fibrosis centre.  J Antimicrob Chemother . 1986;  17 505-516
    PubMedSearch in Google Scholar
  • 47 Denton M, Kerr K, Mooney L. Transmission of colistin-reisistant Pseudomonas aeruginosa between patients attending a pediatric cystic fibrosis center.  Pediatr Pulmonol . 2002;  34 257-261
    CrossrefPubMedSearch in Google Scholar
  • 48 Høiby N, Pedersen S S. Estimated risk of cross-infection with Pseudomonas aeruginosa in Danish cystic fibrosis patients.  Acta Paediatr Scand . 1989;  78 395-404
    PubMedSearch in Google Scholar
  • 49 Farrell P M, Shen G, Splaingard M. et al . Acquisition of Pseudomonas aeruginosa in children with cystic fibrosis.  Pediatrics . 1997;  100(5) E21-E29
    PubMedSearch in Google Scholar
  • 50 Frederiksen B, Koch C, Høiby N. Changing epidemiology of Pseudomonas aeruginosa infection in Danish cystic fibrosis patients (1974-1995).  Pediatr Pulmonol . 1999;  8 159-166
    PubMedSearch in Google Scholar
  • 51 Vandamme P, Holmes B, Vancanneyt M. et al . Occurrence of multiple genomovars of Burkholderia cepacia in cystic fibrosis patients and proposal of Burkholderia multivorans sp. nov.  Int J Syst Bacteriol . 1997;  47 1188-1200
    CrossrefPubMedSearch in Google Scholar
  • 52 Coenye T, Schouls L M, Govan J R, Kersters K, Vandamme P. Identification of Burkholderia species and genomovars from cystic fibrosis patients by AFLP fingerprinting.  Int J Syst Bacteriol . 1999;  49 1657-1666
    PubMedSearch in Google Scholar
  • 53 Coenye T, LiPuma J J. Multilocus restriction typing: a novel tool for studying global epidemiology of Burkholderia cepacia complex infection in cystic fibrosis.  J Infect Dis . 2002;  185 1454-1462
    CrossrefPubMedSearch in Google Scholar
  • 54 Barker P M, Wood R E, Gilligan P H. Lung infection with Burkholderia gladioli in a child with cystic fibrosis: acute clinical and spirometric deterioration.  Pediatr Pulmonol . 1997;  23 123-125
    CrossrefPubMedSearch in Google Scholar
  • 55 Ledson M J, Gallagher M J, Walshaw M J. Chronic Burkholderia cepacia bronchiectasis in a non-cystic fibrosis individual.  Thorax . 1998;  53 430-433
    PubMedSearch in Google Scholar
  • 56 Isles A, Maclusky I, Corey M. et al . Pseudomonas cepacia infection in cystic fibrosis: an emerging problem.  J Pediatr . 1984;  104 206-210
    CrossrefPubMedSearch in Google Scholar
  • 57 Tablan O C, Martone W J, Doershuk C F. et al . Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis: Risk factors and outcomes.  Chest . 1987;  91 527-532
    CrossrefPubMedSearch in Google Scholar
  • 58 Tomashefski J F, Thomasse M J, Bruce M C, Goldberg H I, Konstan M W, Stern R C. Pseudomonas cepacia-associated pneumonia in cystic fibrosis.  Arch Pathol Lab Med . 1988;  112 166-172
    PubMedSearch in Google Scholar
  • 59 Lewin L O, Byard P J, Davis P B. Effect of Pseudomonas cepacia colonization on survival and pulmonary function of cystic fibrosis patients.  J Clin Epidemiol . 1990;  43 125-131
    CrossrefPubMedSearch in Google Scholar
  • 60 Nelson J W, Doherty C J, Brown P H, Greening A P, Kaufmann M E, Govan J RW. Pseudomonas cepacia in inpatients with cystic fibrosis.  Lancet . 1991;  338 1525
    PubMedSearch in Google Scholar
  • 61 Mahenthiralingam E, Vandamme P, Campbell M E. et al . Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans Clin Infect Dis .  2001;  33 1469-1475
    CrossrefPubMedSearch in Google Scholar
  • 62 Aris R M, Routh J C, LiPuma J J, Heath D G, Gilligan P H. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: survival linked to genomovar type.  Am J Respir Crit Care Med . 2001;  164 2102-2106
    CrossrefPubMedSearch in Google Scholar
  • 63 Shaw D, Poxton I R, Govan J RW. Biological activity of Burkholderia (Pseudomonas) cepacia lipopolysaccharide.  FEMS Immunol Med Microbiol . 1995;  11 99-106
    PubMedSearch in Google Scholar
  • 64 Burns J L, Jonas M, Chi E Y, Clark D K, Berger A, Griffith A. Invasion of respiratory epithelial cells by Burkholderia (Pseudomonas) cepacia Infect Immun .  1996;  64 4054-4059
    PubMedSearch in Google Scholar
  • 65 Fisher M C, LiPuma J J, Dasen S E. et al . Source of Pseudomonas cepacia-ribotyping of isolates from patients and from the environment.  J Pediatr . 1993;  123 754-757
    PubMedSearch in Google Scholar
  • 66 Butler S L, Doherty C J, Hughes J E, Nelson J W, Govan J R. Burkholderia cepacia and cystic fibrosis: do natural environments present a potential hazard?.  J Clin Microbiol . 1995;  33 1001-1004
    PubMedSearch in Google Scholar
  • 67 Holmes A, Govan J, Goldstein R. Agricultural use of Burkholderia (Pseudomonas) cepacia: a threat to human health?.  Emerg Infect Dis . 1998;  4 221-227
    PubMedSearch in Google Scholar
  • 68 Mortensen J E, Fisher M C, LiPuma J J. Recovery of Pseudomonas cepacia and other Pseudomonas species from the environment.  Infect Control Hosp Epidemiol . 1995;  16 30-32
    CrossrefPubMedSearch in Google Scholar
  • 69 Gonzalez C F, Mark G L, Mahenthiralingam E, LiPuma J J. Isolation of soilborne genomovar III Burkholderia cepacia and lytic phages with inter-genomovar host range.  Pediatr Pulmonol . 2000;  suppl 20 S288-S289
    PubMedSearch in Google Scholar
  • 70 Balandreau J, Viallard V, Cournoyer B, Coenye T, Laevens S, Vandamme P. Burkholderia cepacia genomovar III is a common plant-associated bacterium.  Appl Environ Microbiol . 2001;  67 982-985
    CrossrefPubMedSearch in Google Scholar
  • 71 LiPuma J J, Spilker T, Coenye T, Gonzalez C F. An epidemic Burkholderia cepacia complex strain identified in soil.  Lancet . 2002;  359 2002-2003
    CrossrefPubMedSearch in Google Scholar
  • 72 Sajjan U S, Sun L, Goldstein R, Forstner J F. Cable (Cbi) type 11 pili of cystic fibrosis-associated Burkholderia (Pseudomonas) cepacia: nucleotide sequence of the cblA major subunit pilin gene and novel morphology of the assembled appendage fibers.  J Bacteriol . 1995;  177 1030-1038
    PubMedSearch in Google Scholar
  • 73 Sun L, Jiang R Z, Steinbach S. et al . The emergence of a highly transmissible lineage of cbl+ Pseudomonas (Burkholderia) cepacia causing CF centre epidemics in North America and Britain.  Nat Med . 1995;  1 661-666
    CrossrefPubMedSearch in Google Scholar
  • 74 Govan J R, Deretic V. Microbial pathogenesis in cystic fibrosis: mucoid Pseudomonas aeruginosa and Burkholderia cepacia Microbiol Rev .  1996;  60 539-574
    PubMedSearch in Google Scholar
  • 75 Mahenthiralingam E, Simpson D A, Speert D P. Identification and characterization of a novel DNA marker associated with epidemic Burkholderia cepacia strains recovered from patients with cystic fibrosis.  J Clin Microbiol . 1997;  35 808-816
    PubMedSearch in Google Scholar
  • 76 Holmes A, Nolan R, Taylor R. et al . An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis.  J Infect Dis . 1999;  179 1197-1205
    CrossrefPubMedSearch in Google Scholar
  • 77 LiPuma J J, Spilker T, Gill L H, Cambell P W, Liu L, Mahenthiralingam E. Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis.  Am J Respir Crit Care Med . 2001;  164 92-96
    CrossrefPubMedSearch in Google Scholar
  • 78 Chen J S, Witzmann K A, Spilker T, Fink R J, LiPuma J J. Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis.  J Pediatr . 2001;  139 643-649
    CrossrefPubMedSearch in Google Scholar
  • 79 Pedersen S S, Jensen T, Pressler T, Høiby N. Does centralized treatment of cystic fibrosis increase the risk of Pseudomonas aeruginosa infection?.  Acta Paediatr Scand . 1986;  75 840-845
    PubMedSearch in Google Scholar
  • 80 Editorial. Pseudomonas cepacia: more than a harmless commensal .  Lancet . 1992;  339 1385-1386
    CrossrefPubMedSearch in Google Scholar
  • 81 Thomassen M J, Demko C A, Doershuk C F, Stern R C, Klinger J D. Pseudomonas cepacia: decrease in colonization in patients with cystic fibrosis.  Am Rev Respir Dis . 1986;  134 669-671
    PubMedSearch in Google Scholar
  • 82 Hardy K A, McGowan K L, Fisher M C, Schidlow D V. Pseudomonas cepacia in the hospital setting: lack of transmission between cystic fibrosis patients.  J Pediatr . 1986;  109 51-54
    PubMedSearch in Google Scholar
  • 83 LiPuma J J, Dasen S E, Nielson D W, Stern R C, Stull T L. Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis.  Lancet . 1990;  336 1094-1096
    CrossrefPubMedSearch in Google Scholar
  • 84 Millar-Jones L, Paull A, Saunders Z, Goodchild M C. Transmission of Pseudomonas cepacia among cystic fibrosis patients.  Lancet . 1992;  340 491
    CrossrefPubMedSearch in Google Scholar
  • 85 Smith D L, Smith E G, Gunnery L B, Stableforth D E. Pseudomonas cepacia infection in cystic fibrosis.  Lancet . 1992;  339 252
    PubMedSearch in Google Scholar
  • 86 Govan J R, Brown P H, Maddison J. et al . Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis.  Lancet . 1993;  342 15-19
    CrossrefPubMedSearch in Google Scholar
  • 87 Pitt T L, Kaufmann M E, Patel P S, Benge L CA, Gaskin S, Livermore D M. Type characterisation and antibiotic susceptibility of Burkholderia (Pseudomonas) cepacia isolates from patients with cystic fibrosis in the United Kingdom and the Republic of Ireland.  J Med Microbiol . 1996;  44 203-210
    CrossrefPubMedSearch in Google Scholar
  • 88 Govan J RW, Nelson J W. Microbiology of cystic fibrosis lung infections-themes and issues.  J R Soc Med. 1993b;  86(suppl 20) S11-S18
    PubMedSearch in Google Scholar
  • 89 Smith D L, Smith E G, Gumery L B, Stableforth D E, Dalla Costa M L>&, Pitt T L. Epidemiology of Pseudomonas aeruginosa infection in cystic fibrosis and the use of strain genotyping.  J Infect . 1993;  26 325-331
    CrossrefPubMedSearch in Google Scholar
  • 90 Burdge D R, Nakielna E M, Noble M A. Case-control and vector studies of nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.  Infect Control Hosp Epidemiol . 1993;  14 127-130
    PubMedSearch in Google Scholar
  • 91 LiPuma J J, Marks-Austin K A, Holsclaw D S, Winnie G B, Gilligan P H, Stull T L. Inapparent transmission of Pseudomonas (Burkholderia) cepacia among patients with cystic fibrosis.  Pediatr Infect Dis J . 1994;  13 716-719
    PubMedSearch in Google Scholar
  • 92 Pegues D A, Carson L A, Tablan O C. et al . Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis.  J Pediatr . 1994;  124 694-702
    PubMedSearch in Google Scholar
  • 93 Pegues D A, Schidlow D V, Tablan O C, Carson L A, Clark N C, Jarvis W R. Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis.  Arch Pediatr Adolesc Med. 1994b;  148 805-812
    PubMedSearch in Google Scholar
  • 94 Johansen H K, Kovesi T A, Koch C, Corey M, Høiby N, Levison H. Pseudomonas aeruginosa and Burkholderia cepacia infection in cystic fibrosis patients treated in Toronto and Copenhagen.  Pediatr Pulmonol . 1998;  26 89-96
    CrossrefPubMedSearch in Google Scholar
  • 95 Muhdi K, Edenborough F P, Gumery L. et al . Outcome for patients colonised with Burkholderia cepacia in a Birmingham adult cystic fibrosis clinic and the end of an epidemic.  Thorax . 1996;  51 374-377
    CrossrefPubMedSearch in Google Scholar
  • 96 Paul M L, Pegler M AM, Benn R AV. Molecular epidemiology of Burkholderia cepacia in two Australian cystic fibrosis centres.  J Hosp Infect . 1998;  38 19-26
    CrossrefPubMedSearch in Google Scholar
  • 97 Webb A K, Govan J R. Burkholderia cepacia: another twist and a further threat.  Thorax . 1998;  53 333-334
    CrossrefPubMedSearch in Google Scholar
  • 98 Fung S K, Dick H, Devlin H, Tullis E. Transmissibility and infection control implications of Burkholderia cepacia in cystic fibrosis.  Can Infect Dis J . 1998;  9 177-182
    PubMedSearch in Google Scholar
  • 99 Saiman L, MacDonald N, Burns J L, Høiby N, Speert D P, Weber D. Infection control in cystic fibrosis: practical recommendations for the hospital, clinic, and social settings.  Am J Infect Control . 2000;  28 381-385
    CrossrefPubMedSearch in Google Scholar
  • 100 Elting L S, Khardori N, Bodey G P, Fainstein V. Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors.  Infect Control Hosp Epidemiol . 1990;  11 134-138
    PubMedSearch in Google Scholar
  • 101 Denton M, Kerr K G. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia Clin Microbiol Rev .  1998;  11 57-80
    CrossrefPubMedSearch in Google Scholar
  • 102 Sattler C, Mason E J, Kaplan S. Nonrespiratory Stenotrophomonas maltophilia infection at a children's hospital.  Clin Infect Dis . 2000;  31 1321-1330
    CrossrefPubMedSearch in Google Scholar
  • 103 Burns J L, Emerson J, Stapp J R. Microbiology of sputum from patients at cystic fibrosis centers in the United States.  Clin Infect Dis . 1998;  27 158-163
    CrossrefPubMedSearch in Google Scholar
  • 104 Demko C A, Stern R C, Doershuk C F. Stenotrophomonas maltophilia in cystic fibrosis: incidence and prevalence.  Pediatr Pulmonol . 1998;  25 304-308
    CrossrefPubMedSearch in Google Scholar
  • 105 Talmaciu I, Varlotta L, Mortensen J, Schidlow D V. Risk factors for emergence of Stenotrophomonas maltophilia in cystic fibrosis.  Pediatr Pulmonol . 2000;  30 10-15
    CrossrefPubMedSearch in Google Scholar
  • 106 Graff G R, Burns J L. Factors affecting the incidence of Stenotrophomonas maltophilia isolation in cystic fibrosis.  Chest . 2002;  121 1754-1760
    CrossrefPubMedSearch in Google Scholar
  • 107 Karpati F, Malmborg A S, Alfredsson H, Hjelte L, Strandvik B. Bacterial colonization with Xanthomonas maltophilia: a retrospective study in a cystic fibrosis patient population.  Infection . 1994;  22 258-263
    CrossrefPubMedSearch in Google Scholar
  • 108 Goss C H, Otto K, Aitken M L, Rubenfeld G D. Detecting Stenotrophomonas maltophilia does not reduce survival in patients with cystic fibrosis.  Am J Respir Crit Care Med . 2002;  166 356-361
    CrossrefPubMedSearch in Google Scholar
  • 109 Gladman G, Connor P J, Williams R F, David T J. Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis.  Arch Dis Child . 1992;  67 192-195
    PubMedSearch in Google Scholar
  • 110 Hutchison M L, Bonell E C, Poxton I R, Govan J RW. Endotoxic activity of lipopolysaccharides isolated from emergent potential cystic fibrosis pathogens.  FEMS Immunol Med Microbiol . 2000;  27 73-77
    PubMedSearch in Google Scholar
  • 111 Dunne Jr M W, Maisch S. Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction.  Clin Infect Dis . 1995;  20 836-841
    CrossrefPubMedSearch in Google Scholar
  • 112 Vu-Thien H, Moissenet D, Valcin M, Dulot C, Tournier G, Garbarg-Chenon A. Molecular epidemiologiy of Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans in a cystic fibrosis center.  Eur J Clin Microbiol Infect Dis . 1996;  15 876-879
    CrossrefPubMedSearch in Google Scholar
  • 113 Valdezate S, Vindel A, Maiz L, Bequero F, Escobar H, Canton R. Persistence and variability of Stenotrophomonas maltophilia in cystic fibrosis patients, Madrid, 1991-1998.  Emerg Infect Dis . 2001;  7 113-121
    PubMedSearch in Google Scholar
  • 114 Krzewinski J W, Nguyen C D, Foster J M, Burns J L. Use of random amplified polymorphic DNA PCR to examine epidemiology of Stenotrophomonas maltophilia and Achromobacter (Alcaligenes) xylosoxidans from patients with cystic fibrosis.  J Clin Microbiol . 2001;  39 3597-3602
    CrossrefPubMedSearch in Google Scholar
  • 115 Murray P R, Baron E J, Pfaller M A, Tenover F C, Yolken R H. Manual of Clinical Microbiology 7th ed.  Washington, DC: ASM Press; 1999
    Search in Google Scholar
  • 116 Fabbri A, Tacchella A, Manno G, Viscoli C, Palmero C, Gargani G F. Emerging microorganisms in cystic fibrosis.  Chemioterapia . 1987;  6 32-37
    PubMedSearch in Google Scholar
  • 117 Moissenet D, Baculard A, Valcin M. et al . Colonization by Alcaligenes xylosoxidans in children with cystic fibrosis: a retrospective clinical study conducted by means of molecular epidemiological investigation.  Clin Infect Dis . 1997;  24 274-275
    PubMedSearch in Google Scholar
  • 118 Smith M J, Efthimiou J, Hodson M E, Batten J C. Mycobacterial isolations in young adults with cystic fibrosis.  Thorax . 1984;  39 369-375
    CrossrefPubMedSearch in Google Scholar
  • 119 Kilby J M, Gilligan P H, Yankaskas J R, Highsmith W E, Edwards L J, Knowles M R. Nontuberculous mycobacteria in adult patients with cystic fibrosis.  Chest . 1992;  102 70-75
    CrossrefPubMedSearch in Google Scholar
  • 120 Aitken M L, Burke W, McDonald G, Wallis C, Ramsey B, Nolan C. Nontuberculous mycobacterial disease in adult cystic fibrosis patients.  Chest . 1993;  103 1096-1099
    CrossrefPubMedSearch in Google Scholar
  • 121 Hjelt K, Højlyng N, Howitz P. et al . The role of mycobacteria other than tuberculosis (MOTT) in patients with cystic fibrosis.  Scand J Infect Dis . 1994;  26 569-576
    CrossrefPubMedSearch in Google Scholar
  • 122 Olivier K N, Yankaskas J R, Knowles M R. Nontuberculous mycobacterial pulmonary disease in cystic fibrosis.  Semin Respir Infect . 1996;  11 272-284
    PubMedSearch in Google Scholar
  • 123 Olivier K, Handler A, Less J H, Tudor G, Knowles M R. Clinical impact of nontuberculous mycobacteria on the course of cystic fibrosis lung disease.  Pediatr Pulmonol Suppl . 2000;  20 102-103
    PubMedSearch in Google Scholar
  • 124 Tomashefski Jr F J, Stern R C, Demko C A, Doershuk C F. Nontuberculous mycobacteria in cystic fibrosis: an autopsy study.  Am J Respir Crit Care Med . 1996;  154 523-528
    CrossrefPubMedSearch in Google Scholar
  • 125 Fauroux B, Delaisi B, Clement A. et al . Mycobacterial lung disease in cystic fibrosis: a prospective study.  Pediatr Infect Dis J . 1997;  16 354-358
    CrossrefPubMedSearch in Google Scholar
  • 126 Oermann C M, Starke J R, Seilheimer D K. Pulmonary disease caused by Mycobacterium kansasii in a patient with cystic fibrosis.  Pediatr Infect Dis J . 1997;  16 257-259
    CrossrefPubMedSearch in Google Scholar
  • 127 Cullen A R, Cannon C L, Mark E J, Colin A A. Mycobacterium abscessus infection in cystic fibrosis: colonization or infection?.  Am J Respir Crit Care Med . 2000;  161 641-645
    PubMedSearch in Google Scholar
  • 128 Oliver A, Maiz L, Canton R, Escobar H, Baquero F, Gomez-Mampaso E. Nontuberculous mycobacteria in patients with cystic fibrosis.  Clin Infect Dis . 2001;  32 1298-1303
    PubMedSearch in Google Scholar
  • 129 Wallace Jr J R, Brown B A, Griffith D E. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria.  Annu Rev Microbiol . 1998;  52 453-490
    CrossrefPubMedSearch in Google Scholar
  • 130 Bange F C, Brown B A, Smaczny C, Wallace Jr J R, Bottger E C. Lack of transmission of Mycobacterium abscessus among patients with cystic fibrosis attending a single clinic.  Clin Infect Dis . 2001;  32 1648-1650
    CrossrefPubMedSearch in Google Scholar