The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.

Vertex Pharmaceuticals.

This report describes the molecular epidemiology, in vitro susceptibility, colonial and microscopic morphologies, and biochemical features of Trichosporon mycotoxinivorans, a newly recognized pathogen that appears to have a propensity for patients with cystic fibrosis. The index patient died with histologically documented Trichosporon pneumonia complicating cystic fibrosis. This is also the first report of disease caused by a Trichosporon species in a nontransplant patient with cystic fibrosis. As T. mycotoxinivorans has not previously been recognized as a respiratory pathogen, the significance of its recovery from sputum samples was not initially appreciated. Genetic analysis of archived clinical samples found three additional cases of T. mycotoxinivorans infection which had previously been identified as other members of the genus. An additional isolate of T. mycotoxinivorans was identified from a clinical sample on initial testing. Three of these four cases were also patients with cystic fibrosis. All isolates had MICs at 48 h of amphotericin B of >1 g/ml and of echinocandins of >16 g/ml, but they displayed various susceptibilities to the triazoles. In summary, Trichosporon mycotoxinivorans is a newly recognized human pathogen that is associated with cystic fibrosis.Trichosporon species are uncommon but potentially lifethreatening causes of localized and disseminated infections in immunocompromised patients. The most common species causing deep-seeded disseminated infection that has been recognized is Trichosporon asahii (11). Other species of Trichosporon are seldom reported as causes of deep-seeded infections. Herein, we describe the first case of human disease caused by Trichosporon mycotoxinivorans. Previously recognized as an industrial source for detoxification of mycotoxins, T. mycotoxinivorans has not been reported to cause disease in humans (20,28). Additional testing of archived isolates of the genus Trichosporon at the University of Texas San Antonio Fungus Testing Laboratory (FTL) revealed three additional cases, including two in patients with cystic fibrosis. These isolates had previously been classified under other species of Trichosporon on the basis of their biochemical profiles alone. A newly acquired sample in the FTL collection, from a cystic fibrosis patient, was also analyzed and identified as T. mycotoxinivorans. This report describes the molecular epidemiology, in vitro susceptibility, colonial and microscopic morphologies, and biochemical features of T. mycotoxinivorans, a newly recognized pathogen that appears to have a propensity for patients with cystic fibrosis. Index case.A 20-year-old male with a history of cystic fibrosis presented to the emergency department complaining of acute onset of dyspnea. He was found to have a right-sided pneumothorax. He was treated with supplemental oxygen, a chest tube was placed, and he was then admitted to the ward for supportive care. His recent medical history was notable for receiving home therapy with piperacillin-tazobactam and trimethoprim-su...