Article

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: 2.03). 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.

0 Bookmarks
 · 
64 Views
  • [Show abstract] [Hide abstract]
    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 01/2014; · 3.19 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the efficacy and safety of liposomal clarithromycin formulations of different surface charges against clinical isolates of Pseudomonas aeruginosa from the lung of cystic fibrosis (CF) patients. The liposomal clarithromycin formulations were prepared by the dehydration-rehydration method and their sizes were measured using the dynamic light scattering technique. Encapsulation efficiency was determined by microbiological assay and stability of the formulations in biological fluid was evaluated for a period of 48 h. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of free and liposomal formulations were determined with P. aeruginosa strains isolated from CF patients. Liposomal clarithromycin activity against biofilm forming P. aeruginosa was compared to free antibiotic using the Calgary Biofilm Device (CBD). The effect of subinhibitory concentrations of free and liposomal clarithromycin on bacterial virulence factors and motility on agar was investigated on clinical isolates of P. aeruginosa. The cytotoxicity of the liposome preparations and free drug were evaluated on a pulmonary epithelial cell line (A549). The average size of the formulations was >222 nm in diameter with an encapsulation efficiency ranging from 5.7% to 30.4%. The liposomes retained more than 70% of their drug content during the 48 h time-period. The highly resistant strains of P. aeruginosa became susceptible to liposome encapsulated clarithromycin (MIC of 256 mg/L vs. 8 mg/L, P<0.001). Liposomal clarithromycin reduced the bacterial growth within the biofilm by 3-4 logs (P<0.001), significantly attenuated the virulence factors production, and reduced bacterial twitching, swarming and swimming motilities. The clarithromycin-entrapped liposomes were less cytotoxic than the free drug (P<0.001). These data indicate that our novel formulations could be a useful strategy to enhance the efficacy of clarithromycin against resistant P. aeruginosa strains that commonly affect individuals with cystic fibrosis.
    Antimicrobial Agents and Chemotherapy 04/2013; · 4.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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.

Full-text

View
1 Download
Available from

Similar Publications