Infection control knowledge, beliefs and behaviours amongst cystic fibrosis patients with epidemic Pseudomonas aeruginosa

Abstract

BackgroundEpidemic P. aeruginosa (ePA) infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline. Factors associated with ePA are unclear, and evidence based infection control interventions are lacking.MethodsWe prospectively collect all bacterial pathogens from adult CF patients. We performed PA strain typing on retrospectively collected enrolment samples and recent isolates to identify patients infected with ePA. All patients attending our clinic were approached to complete a survey on infection control knowledge, beliefs and exposures. We analyzed responses of those with ePA relative to the entire cohort without ePA as well as those infected with unique strains of P. aeruginosa to assess for risk factors for ePA and differences in infection control knowledge, beliefs or behaviours.ResultsOf 144 participants, 30 patients had ePA (two Liverpool epidemic strain, 28 Prairie epidemic strain), 83 % of which had established infection prior to transition to the adult clinic. Risk of concomitant infecting pathogens was no different between groups although, Staphylococcus aureus and non-tuberculous mycobacteria were less common in those with ePA. Patients with ePA were more likely to have attended CF-camp and have a history of CF fundraising. Patients with ePA did not differ with respect to beliefs regarding pathogens or transmission risk, except they believed indirect contact posed little risk. Furthermore, patients with ePA were more likely to continue to associate with others with CF despite extensive counselling. Use of peer-peer online networking was minimal in both groups.ConclusionInfections with ePA are closely linked to past exposures, now routinely discouraged. As socialization is the greatest risk factor for ePA, infection control strategies for ePA must focus on discouraging face-to-face interactions amongst CF patients. As peer support remains a desire amongst patients, investment in technologies and strategies that enable indirect communication and support are required.

Prevalence and Outcomes of Achromobacter Species Infections in Adults with Cystic Fibrosis: a North American Cohort Study

“…Extreme variations in the prevalence of shared clones of other organisms known to be transmissible (e.g., P. aeruginosa) exist in different clinics, reflecting some combination of organism fitness, patient population, and historical infection control practices. In our center, where an epidemic P. aeruginosa strain accounts for Ͼ1/3 of all chronic infections, we confirmed that no true shared infections occurred (49). Uniquely relative to other studies of infection transmission in CF patients, we sought to confirm potential patient-patient spread not only through WGS but also by assessing other organisms in the same sputum.…”

Epidemiology, Biology, and Impact of Clonal Pseudomonas aeruginosa Infections in Cystic Fibrosis

“…Longitudinal sampling enabled the observation of multiple PES superinfections, but these occurred exclusively in patients already infected with nonclonal strains of P. aeruginosa (40,78). Patients infected with PES were more likely to have had a history of attending CF summer camps and being involved in CF fundraising activities (223). By retrospectively assessing prospectively inventoried isolates in a regional CF biobank, investigators identified the first cultured PES isolate from an adult attending a CF clinic in Calgary from 1979 (40).…”

“…were observed less commonly, suggesting that modulation of resident microflora may be another means by which epidemic P. aeruginosa can influence the disease trajectory. Other works have demonstrated that patients with PES are much less likely than patients with unique P. aeruginosa strains to be coinfected with S. aureus strains (40,223).…”

“…Indeed, coinfected siblings are disproportionally commonly observed among epidemic P. aeruginosa clones (40,142,229). In particular, summer camps and, to a lesser extent, winter camps, which were highly prevalent in the late 1970s and 1980s, are thought to have played an important nodal role in infection transmission and dissemination of epidemic P. aeruginosa strains into naive populations at distant CF centers (186,223). These camps served many purposes, including physical rehabilitation, patient education and motivation, peer support, and peer bonding.…”

“…2). Disturbingly, in a prospective survey of patient beliefs regarding the importance of various infection control practices, patients infected with epidemic P. aeruginosa strains (in particular PES) were more likely to minimize the risk of infection transmission afforded by socialization (223).…”