Cough-generated Aerosols of Pseudomonas aeruginosa and other Bacteria from Cystic Fibrosis Patients.

Department of Respiratory Medicine, Royal Children's Hospital and Health Service District, Brisbane, Australia.
Thorax (Impact Factor: 8.29). 08/2009; 64(11):926-31. DOI: 10.1136/thx.2008.112466
Source: PubMed


Pseudomonas aeruginosa is the most common bacterial pathogen in patients with cystic fibrosis (CF). Current infection control guidelines aim to prevent transmission via contact and respiratory droplet routes and do not consider the possibility of airborne transmission. It was hypothesised that subjects with CF produce viable respirable bacterial aerosols with coughing.
A cross-sectional study was undertaken of 15 children and 13 adults with CF, 26 chronically infected with P aeruginosa. A cough aerosol sampling system enabled fractioning of respiratory particles of different sizes and culture of viable Gram-negative non-fermentative bacteria. Cough aerosols were collected during 5 min of voluntary coughing and during a sputum induction procedure when tolerated. Standardised quantitative culture and genotyping techniques were used.
P aeruginosa was isolated in cough aerosols of 25 subjects (89%), 22 of whom produced sputum samples. P aeruginosa from sputum and paired cough aerosols were indistinguishable by molecular typing. In four cases the same genotype was isolated from ambient room air. Approximately 70% of viable aerosols collected during voluntary coughing were of particles <or=3.3 microm aerodynamic diameter. P aeruginosa, Burkholderia cenocepacia, Stenotrophomonas maltophilia and Achromobacter xylosoxidans were cultivated from respiratory particles in this size range. Positive room air samples were associated with high total counts in cough aerosols (p = 0.003). The magnitude of cough aerosols was associated with higher forced expiratory volume in 1 s (r = 0.45, p = 0.02) and higher quantitative sputum culture results (r = 0.58, p = 0.008).
During coughing, patients with CF produce viable aerosols of P aeruginosa and other Gram-negative bacteria of respirable size range, suggesting the potential for airborne transmission.

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Available from: Claire Wainwright, Oct 09, 2015
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    • "By studying the aerosols produced by infected individuals, we hope to precisely characterize how long virus infectivity persists in suspended aerosol droplets of various sizes. Recent work has begun to address this question for bacterial transmission by patients with cystic fibrosis [8, 9]. The question of droplet survival duration pertains to droplet size distribution and, on this front, there are discrepancies across the literature which are likely due to the varying measurement methodologies and techniques. "
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    BMC Research Notes 08/2014; 7(1):563. DOI:10.1186/1756-0500-7-563
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    • "Curtains have been found to be contaminated with bacteria such as Acinetobacter [17] and have been shown to release S. aureus upon vigorous movement [11]. Other specific bacteria to be sampled from the air include Pseudomonas aeruginosa and Burkholderia cepacia which have been shown to be released in to the air on respirable sized particles [18] from patients coughing as well as after nebuliser use [19]. "
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    • "Such strains have been found in the United Kingdom and Europe (Manchester epidemic strain [MA], Liverpool epidemic strain [LES] [10,11] and Clone C [12]), as well as Canada [13] and Australia (Australian epidemic strain 1 [AES-1] [7]). Increasing evidence suggests that transmission between patients occurs via a cough-associated aerosol route [14,15]. The majority of epidemic strains display evidence of increased virulence in CF patients [16] and transmission to patients with non-CF bronchiectasis, or even otherwise healthy relatives, has been detected [17]. "
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