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.
Highlights
Epidemic P. aeruginosa infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline
Patients chronically infected with many of the Epidemic P. aeruginosa (ePA) strains are associated with a worsened clinical course relative to those infected with unique, non-clonal strains
Like Liverpool Epidemic Strain (LES), Prairie Epidemic Strain (PES) has been associated with a worse baseline lung function and nutritional status, increased rates of lung function decline and progression to end stage lung disease, and are more likely to be resistant to antibiotics [7, 13]
Summary
Epidemic P. aeruginosa (ePA) infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline. We have recently described another ePA, termed the Prairie Epidemic Strain (PES), amongst patients attending the Calgary Adult Cystic Fibrosis Clinic. PES is unique to CF, and was not found causing infection in comparator populations of adults with non-CF bronchiectasis, or community-acquired bacteremia nor during extensive sampling of natural environmental reservoirs or the local hospital sampling [7, 12]. This strain was evident at first encounter amongst multiple patients transferring to our adult clinic from other Western Canadian CF clinics suggesting PES is prevalent across the Prairies [7]. Like LES, PES has been associated with a worse baseline lung function and nutritional status, increased rates of lung function decline and progression to end stage lung disease, and are more likely to be resistant to antibiotics [7, 13]
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