Long-term clinical outcomes of ‘Prairie Epidemic Strain’Pseudomonas aeruginosainfection in adults with cystic fibrosis

Abstract

Infection with PES was associated with increased patient morbidity through three decades and manifested in an increased risk of respiratory death and/or lung transplantation.

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

“…Confounding this is the important distinction that the frequencies of individual clones (even established epidemic clones) may differ from center to center. It is possible that a strain that is epidemic at one site may exist merely infrequently at another site where circumstances do not permit its broad dissemination into a naive population (40,75,80). In these other locales, the fact that the numbers of these particular strains have not managed to increase suggests that in addition to having a strain-specific capacity for transmission, environmental and host factors are required as well ( Fig.…”

“…LES infects 15% of CF adults in Ontario, Canada, where it has been found in patients from every part of the province and in over 80% of clinics. Furthermore, sporadic cases have been identified in Australia (96), Spain (185), and other parts of Canada (40), when patients have moved from zones of endemicity to new locales. How LES spread transcontinentally is not clear, but it has been speculated that it transitioned across the Atlantic when children from the United Kingdom attended CF summer camps in Canada (186).…”

“…However, it was thought not to represent an epidemic strain at that time, as infection was often transient. However, it has since been identified in 33% of P. aeruginosa-infected patients in the most immediate neighboring CF clinic (Calgary, Canada), approximately 1,000 km away (40,78,102,146). Importantly, patients newly referred to the Calgary adult CF clinic, referred from pediatric and adult CF clinics from other Western Canadian provinces, were identified to be chronically infected with this strain at first assessment, suggesting broad endemicity of PES in the Prairie Provinces of Canada.…”

“…Importantly, patients newly referred to the Calgary adult CF clinic, referred from pediatric and adult CF clinics from other Western Canadian provinces, were identified to be chronically infected with this strain at first assessment, suggesting broad endemicity of PES in the Prairie Provinces of Canada. 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).…”

“…Radiographic scores and symptom scores, including cough, are worse in those with chronic P. aeruginosa infection (35,36), and nutritional status is similarly worsened compared to those without chronic infection (32). Most importantly, many studies demonstrate that progression to end-stage lung disease and death is more rapid in those with chronic infection than in those without (34,(37)(38)(39)(40).…”