Infection control in cystic fibrosis: cohorting, cross-contamination, and the respiratory therapist.

Department of Respiratory Care, Children's Memorial Hospital, 2300 Children's Plaza, Box 58, Chicago, IL 60614, USA.
Respiratory care (Impact Factor: 1.84). 06/2009; 54(5):641-57. DOI: 10.4187/aarc0446
Source: PubMed

ABSTRACT Cystic fibrosis (CF) is a complex genetic disease characterized by lung infections that lead to early morbidity and death. Pathogens that commonly infect the lungs of patients with CF include Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, and Burkholderia cepacia. Aggressively treating pulmonary infection with antibiotics has contributed to improved survival in patients with CF but has also promoted multiple-drug-resistant bacteria. Other complexities include the ability of bacteria to form biofilms, which makes them more resistant to antibiotics, and emerging pathogens in CF, of which the clinical importance is not yet clear. Increasing evidence of patient-to-patient transmission of CF pathogens led the Cystic Fibrosis Foundation to produce evidence-based infection-control recommendations, which stress 4 principles: standard precautions, transmission-based precautions, hand hygiene, and care of respiratory equipment. Respiratory therapists need to know and follow these infection-control recommendations. Cohorting patients infected with B. cepacia complex is one of several interventions successful at keeping the spread of this pathogen low, but cohorting patients who are infected/colonized with other microbes is controversial, the main argument of which is not being certain of a patient's present respiratory culture status at any given patient visit.

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    ABSTRACT: Die Entdeckung des Zystische-Fibrose-Transmembran-Regulator-(CFTR-)Gens im Jahr 1989 gab Grund zur Hoffnung, dass eine kausale Therapie der Mukoviszidose (CF) in Kürze verfügbar sein würde. Obwohl Wissenschaftler Fortschritte in Bezug auf die Korrektur des zugrundeliegenden Defekts auf Genebene erreicht haben, gibt es bislang keine verfügbare Therapie mit diesem Ansatz. Neue mutationsspezifische Therapiekonzepte stützen sich auf die Korrektur des Fehlers auf Proteinebene. Mehr als 1900 Mutationen wurden beschrieben und in verschiedene Klassen eingeteilt, je nachdem, ob eine vorzeitige Beendigung der Translation (sog. Stopp-Mutationen) oder anderen funktionelle Verluste vorliegen. Mit der Zulassung einer ersten, speziell für eine bestimmte Klasse von Mutationen wirksamen Therapie, schaffte die individualisierte Therapie bei CF ihren Weg in die klinische Praxis. Darüber hinaus wurden Fortschritte bei der Entwicklung und Zulassung neuer symptomorientierter Therapien gemacht. Über den Defekt des CFTR hinaus ist es in den letzten Jahren sehr deutlich geworden, dass ein Großteil der pulmonalen Manifestationen der CF-Lungenerkrankung auch durch modifizierende Gene und Umweltfaktoren bestimmt wird. Weitere wichtige Fortschritte der letzten 10 Jahre sind durch die Einführung von europäischen Standards für die Patientenversorgung und durch die Entwicklung von Forschungsverbünden sowie nationalen und europäischen Strukturen für klinische Studien begründet. Dies schafft die Grundlage für eine systematische Neuordnung der CF-Therapie im nächsten Jahrzehnt.
    Der Pneumologe 06/2013; 10.
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    ABSTRACT: Pseudomonas aeruginosa is one of the important causes of hospital-acquired infections in Intensive Care Unit (ICU) and considered as a major determinant of morbidity and mortality in patients affected by cystic fibrosis (CF). The aim of this study was to investigate clonal diversity among randomly picked P. aeruginosa isolates of CF and the other hospitalized patients in ICU. Cultivation, identification, and antimicrobial susceptibility testing of P. aeruginosa isolates were performed using standard techniques. The genetic similarity of the strains was investigated by amplification of the Enterobacterial Repetitive Intergenic Consensus-polymerase chain reaction (ERIC-PCR) sequence. Among 49 isolates, sixteen were isolated from 11 patients affected by CF and 33 came from an epidemiological investigation of 25 P. aeruginosa infected patients of ICU. Five clusters were generated for all isolates analyzed through ERIC-PCR genotyping. Two major clusters (B and C) were discovered in P. aeruginosa isolates of ICU and CF patients during the whole period of this study. Fifteen unique antibiogram patterns obtained from all isolates and multi-resistant P. aeruginosa (MRPA) were identified in 23 isolates (47%). MRPA isolates were detected in all clusters (except A) while pan-resistant isolates were recovered only in cluster C. The high prevalence of related or identical isolates in CF and non-CF patients can be due to transmission of particular dominant clones in ICU ward. Therefore, enhanced infection-control may become necessary to prevent further spread of clonal strains.
    Journal of preventive medicine and hygiene 03/2013; 54(1):24-8.
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    ABSTRACT: Background Pneumococcal immunization is recommended in children with cystic fibrosis (CF). To date, however, there are no published studies on the efficacy of pneumococcal vaccination in this group of patients. Methods We carried out a retrospective study of serotype-specific pneumococcal antibody responses to immunization with Prevenar 7 and Pneumovax II in a cohort of children with CF. Results Nine children had been immunized with Prevenar 7, and all had serotype-specific pneumococcal antibody levels in the protective range (> 0.35 mg/L) to all 7 immunizing serotypes. In contrast, only 7 of 33 patients (21%) immunized with Pneumovax II made protective antibody responses to all 7 serotypes, and 3 failed to make protective antibodies to any of the serotypes. Controlling for age as a confounder in the analysis, children with impaired antibody responses to pneumococcal polysaccharide (Pneumovax II) immunization had lower Shwachman–Kulczycki scores than children with normal polysaccharide antibody responses. All isolates of Pseudomonas aeruginosa occurred in patients with impaired anti-pneumococcal antibody responses, and a broader range of respiratory pathogens was isolated from these children. Conclusions Impaired antibody responses to immunization with Pneumovax II are common in children with CF and this may be associated with increased disease severity.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 12/2014; · 3.19 Impact Factor


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