Effects of segregation on an epidemic Pseudomonas aeruginosa strain in a cystic fibrosis clinic

被引:67
作者
Griffiths, AL
Jamsen, K
Carlin, JB
Grimwood, K
Carzino, R
Robinson, PJ
Massie, J
Armstrong, DS
机构
[1] Monash Univ, Dept Pediat, Monash Med Ctr, Dept Resp & Sleep Med, Melbourne, Vic 3168, Australia
[2] Univ Melbourne, Dept Pediat, Parkville, Vic 3052, Australia
[3] Murdoch Childrens Res Inst, Clin Epidemiol & Biostat Unit, Parkville, Vic 3052, Australia
[4] Royal Childrens Hosp, Dept Resp Med, Parkville, Vic 3052, Australia
[5] Univ Otago, Wellington Sch Med & Hlth Sci, Dept Pediat & Child Hlth, Wellington, New Zealand
关键词
cross-infection; cystic fibrosis; infection control; Pseudomonas aeruginosa;
D O I
10.1164/rccm.200409-1194OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The detection of a clonal Pseudomonas aeruginosa strain in 21% of children attending a cystic fibrosis clinic during 1999, which may have led to a worse prognosis, prompted strict infection control measures, including cohort segregation. We determined whether these strategies interrupted cross-infection within the clinic. Patients from 1999 were observed and a cross-sectional study of the 2002 clinic was performed. By 2002, the epidemic strain prevalence had decreased from 21 to 14% (p = 0.03), whereas the proportion of patients with nonepidemic P. aeruginosa strains was unchanged. The age- and sex-adjusted relative risk for epidemic strains among sputum producers in 2002 compared with 1999 was 0.64 (95% confidence interval, 0.47, 0.87; p = 0.004). Increased mortality or transfer to another clinic did not explain this reduction. Although children with epidemic strains may have had increased mortality (adjusted odds ratio, 2.0; 95% confidence interval, 0.6-6.8), they did not demonstrate greater morbidity than those with other P. aeruginosa isolates. Successful infection control measures provided additional indirect evidence for person-to-person transmission of an epidemic strain within the clinic. Further studies are needed to resolve whether cohort segregation completely eliminates cross-infection and if acquisition of epidemic isolates is associated with worse outcomes.
引用
收藏
页码:1020 / 1025
页数:6
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