Spread of β-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic

Cheng, Katharine; Smyth, Rosalind L; Govan, John R. W.; Doherty, C.; Winstanley, Craig; Denning, N.; Heaf, D P; Saene, Hkf van

doi:10.1016/s0140-6736(96)05169-0

Cited by 382 publications

(305 citation statements)

References 20 publications

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“…49,50 Nonetheless, antimicrobial susceptibility can distinguish methicillin-susceptible S. aureus (MSSA) from MRSA, identify unique multidrug-resistance patterns, and has been crucial for epidemiologic investigations. For example, CF clinicians were alerted to the transmission of epidemic strains of P. aeruginosa due to the emergence of ceftazidime-resistant, 51 colistin-resistant, 52 or multidrug-resistant strains. 30,53 Thus, susceptibility testing is still recommended as per the 2003 Infection Control Guideline for CF.…”

Section: Cf Ipandc Guideline Consensus: 100%mentioning

confidence: 99%

“…178 In 1996, PFGE analysis of isolates recovered during an antibiotic trial identified a blactam-resistant strain of P. aeruginosa infecting 55 children at a CF center in Liverpool, United Kingdom. 51 Other reports described shared or epidemic P. aeruginosa strains in the United Kingdom and Australia. 53,[179][180][181] PFGE analysis of 1,225 P. aeruginosa isolates recovered from people with CF receiving care in 31 treatment centers in the United Kingdom demonstrated that 28% of those infected harbored a strain shared with at least 1 other person with CF.…”

Section: Iiia2 P Aeruginosamentioning

confidence: 99%

See 1 more Smart Citation

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Saiman

Siegel

LiPuma

et al. 2014

Infect. Control Hosp. Epidemiol.

352

382

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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.

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Section: Cf Ipandc Guideline Consensus: 100%mentioning

confidence: 99%

Section: Iiia2 P Aeruginosamentioning

confidence: 99%

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Saiman

Siegel

LiPuma

et al. 2014

Infect. Control Hosp. Epidemiol.

352

382

View full text Add to dashboard Cite

show abstract

“…This is largely owing to the fact that the majority of studies are prospective in nature and thus unable to determine when the initial transmission event occurred (13,17,28,(36)(37)(38)(39). Critically, the bulk of transmission studies are concentrated in the pediatric patient age group (17,28,36,(38)(39)(40)(41)(42).…”

Section: Figmentioning

confidence: 99%

“…Most studies have been prospective and are thus limited by their short duration of follow-up and lack of historical context. These studies are therefore able to report point prevalences of infection but provide little information on incidence or when infections first occurred (13,17). Accordingly, the development of rational, evidence-based infection control protocols to limit the spread of transmissible organisms has been limited.…”

mentioning

confidence: 99%

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

et al. 2014

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Transmissible strains of Pseudomonas aeruginosa have been described for cystic fibrosis (CF) and may be associated with a worse prognosis. Using a comprehensive strain biobank spanning 3 decades, we sought to determine the prevalence and stability of chronic P. aeruginosa infection in an adult population. P. aeruginosa isolates from sputum samples collected at initial enrollment in our adult clinic and at the most recent clinic visit were examined by a combination of pulsed-field gel electrophoresis and multilocus sequence typing and compared against a collection of established transmissible and local non-CF bronchiectasis (nCFB) isolates. A total of 372 isolates from 107 patients, spanning 674 patient-years, including 66 patients with matched isolates from initial and final encounters, were screened. A novel clone with increased antibacterial resistance, termed the prairie epidemic strain (PES), was found in 29% (31/107 patients) of chronically infected patients referred from multiple prairie-based CF centers. This isolate was not found in those diagnosed with CF as adults or in a control population with nCFB. While 90% (60/66 patients) of patients had stable infection over a mean of 10.8 years, five patients experienced strain displacement of unique isolates, with PES occurring within 2 years of transitioning to adult care. PES has been present in our cohort since at least 1987, is unique to CF, generally establishes chronic infection during childhood, and has been found in patients at the time of transition of patients from multiple prairie-based CF clinics, suggesting broad endemicity. Studies are under way to evaluate the clinical implications of PES infection.

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“…Indeed, a high development of ceftazidime-resistant strains of P. aeruginosa was noted in a small population of CF patients who received ceftazidime monotherapy over a 5-yr period [55,56]. This would imply that antibiotic monotherapy is inferior to combination therapy with P. aeruginosaspecific antibiotics displaying different mode of actions.…”

Section: Antibiotic Resistance Of Pseudomonas Aeruginosa In Cystic Fimentioning

confidence: 99%

Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

Döring¹,

Conway²,

Heijerman³

et al. 2000

Eur Respir J

558

478

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Cystic fibrosis (CF) is the most common lethal hereditary disorder with autosomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathogen Pseudomonas aeruginosa. No consensus among clinicians has been reached so far concerning antibiotic treatment against P. aeruginosa in CF patients.Consensus answers to 24 important questions in this context, based on current evidence, are presented, given by a panel of 34 European experts. Questions addressed and answered are: The diagnosis of P. aeruginosa lung colonization in CF; The impact of P. aeruginosa on the clinical state of CF patients; The assessment of P. aeruginosa susceptibility against antibiotics and the importance of these results for the clinician; The use of monotherapy versus combination therapy; The development of microbial resistance; The achievement of optimal airway concentrations; The effects of subinhibitory concentrations of antibiotics on P. aeruginosa; Statements on the pharmacokinetics of antibiotics in CF patients; Recommendations for doses and dosing intervals and length of treatment regimens; and Toxic side effects due to repeated antibiotic therapy was addressed.The expert panel answered further questions on the use of fluoroquinolones in children with CF, on the administration of nebulized antibiotics and whether prevention of P. aeruginosa lung colonization is possible in CF using antibiotic therapy.Problems of antibiotic therapy at home and in the hospital were addressed, a consensus statement on regular maintenance treatment, or treatment on demand, was given and different routes of administration of antibiotics were recommended for different clinical situations.Finally, the factors which determine the choice of the antibiotic, the dosage, and the duration of the treatment in cystic fibrosis patients were addressed and the design of future antibiotic studies in the context of Pseudomonas aeruginosa lung infection in cystic fibrosis patients were recommended. Eur Respir J 2000; 16: 749±767.

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Spread of β-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic

Cited by 382 publications

References 20 publications

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Twenty-Five-Year Outbreak of Pseudomonas aeruginosa Infecting Individuals with Cystic Fibrosis: Identification of the Prairie Epidemic Strain

Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

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