Transmission and prevalence of Burkholderia cepacia in welsh cystic fibrosis patients

Abstract

From 1987 to 1994, 16 of 162 cystic fibrosis (CF) patients attending CF clinics at three different hospitals in South Wales, U.K. were found to have respiratory secretions colonized with Burkholderia cepacia (B. cepacia). Bacteriological typing by polymerase chain reaction (PCR) ribotyping demonstrated seven strains of B. cepacia among these 16 CF patients. This typing confirmed that cross-infection was the mechanism of colonization in six of the nine patients who were colonized at the paediatric CF clinic at the University Hospital of Wales in Cardiff, and in three of the six patients who were colonized at the adult CF clinic at Llandough Hospital in Cardiff (cross-infection rate nine of 16 patients or 56%). A search was made for a nosocomial source, with screening of wards and clinics. Swabs from fomites produced four positive cultures for B. cepacia. Two isolates had the same PCR ribotype as that of the previous CF room occupant. To establish prevalence of B. cepacia among CF children living throughout Wales, respiratory secretions were cultured from 151 of 186 CF children (age < 16 years). This failed to demonstrate B. cepacia colonization other than in the CF patients already identified.

Elucidating Global Epidemiology of Burkholderia multivorans in Cases of Cystic Fibrosis by Multilocus Sequence Typing

“…In contrast to B. cenocepacia, where direct patient-to-patient contact and socialization have been reported as the most probable mechanisms by which infections were spread (13,26), the mode of transmission for B. multivorans infection has not been determined. Several reports have identified multiple patients in a specific area who acquired the same B. multivorans strain at the same time (4,26,27,31,38).…”

“…This observation may reflect differences in hygiene policies and host susceptibilities or subtle genomic differences among isolates of this strain that may have profound effects upon transmissibility. A finding which adds weight to the notion that ST-16 is perhaps better adapted to human infection than other B. multivorans strains is that it is just a single-locus variant (trpB) of ST-15 and hence part of a clonal complex (CC1; see the supplemental material); thus, two closely related strain types were each associated with infection in multiple patients (27,30,31).…”

“…It is unclear why the incidence of B. cenocepacia has declined and that of B. multivorans has persisted, but it seems most likely that infection control measures are effective at limiting the interpatient spread of "epidemic" B. cenocepacia strains (12, 28). Furthermore, regional differences in B. multivorans recovery rates in cases of CF result in conflicting reports on the emergence and epidemiology of B. multivorans in this population (15,26,27,34,38).The introduction of stringent infection control measures has been shown to reduce the incidence of patient-to-patient spread of B. cenocepacia (5, 26) and presumably has reduced interpatient spread of other BCC species. However, the continued emergence of B. multivorans strains (4, 28) suggests acquisition from other sources, such as the natural environment.…”

“…It is unclear why the incidence of B. cenocepacia has declined and that of B. multivorans has persisted, but it seems most likely that infection control measures are effective at limiting the interpatient spread of "epidemic" B. cenocepacia strains (12, 28). Furthermore, regional differences in B. multivorans recovery rates in cases of CF result in conflicting reports on the emergence and epidemiology of B. multivorans in this population (15,26,27,34,38).…”

Cystic fibrosis adults' perception and management of the risk of infection withBurkholderia cepaciacomplex

“…This centre, in common with others (Govan et al 1993, Millar-Jones et al 1998, was recognized by centre staff as harbouring the risk of cepacia infection for these patients.…”