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Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis
G Gladman1, P J Connor, R F Williams
1Department of Child Health, University of Manchester, Booth Hall Children's Hospital, Blackley.
Insights
Children with cystic fibrosis colonized by Pseudomonas cepacia or Pseudomonas maltophilia showed no unexpected respiratory decline. Further studies are needed to determine if segregation of patients with Pseudomonas cepacia is necessary.
Area of Science:
- Medical Microbiology
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Pseudomonas cepacia and Pseudomonas maltophilia are opportunistic pathogens that can colonize the airways of children with cystic fibrosis.
- Understanding the transmission and clinical impact of these organisms is crucial for patient management.
Purpose of the Study:
- To compare the clinical outcomes of children with cystic fibrosis colonized by Pseudomonas cepacia versus Pseudomonas maltophilia.
- To investigate potential transmission routes and the prevalence of these colonizations over time.
Main Methods:
- Retrospective study comparing two groups of children with cystic fibrosis (CF).
- Data collected between 1983 and 1990 on Pseudomonas cepacia and Pseudomonas maltophilia colonization.
- Analysis included patient age, co-colonization with Pseudomonas aeruginosa, clinical deterioration, and mortality.
Main Results:
- Pseudomonas cepacia colonization occurred at a median age of 12.2 years, while Pseudomonas maltophilia colonization occurred at a median age of 6.1 years.
- Most patients with either organism were also colonized with Pseudomonas aeruginosa.
- No evidence of unexpected respiratory deterioration was observed in patients colonized with Pseudomonas cepacia or Pseudomonas maltophilia compared to controls.
Conclusions:
- Cross-infection may not be the sole transmission route for Pseudomonas cepacia in cystic fibrosis patients, though it cannot be excluded.
- The clinical impact of Pseudomonas cepacia and Pseudomonas maltophilia colonization in cystic fibrosis requires further investigation.
- The need for segregation of patients colonized with Pseudomonas cepacia remains undetermined.
Abstract:
In a retrospective study, children with cystic fibrosis who were colonised with Pseudomonas cepacia were compared with a control group who were colonised with Pseudomonas maltophilia. Out of 216 children with cystic fibrosis seen between 1983 and 1990, P cepacia was recovered from 13 (median age at colonisation 12.2 years) and P maltophilia from 23 (median age at first colonisation 6.1 years), and both organisms were recovered in five cases. With the exception of two patients with P cepacia in whom no other pathogens were found, all the patients with P cepacia or P maltophilia had co-colonisation with Pseudomonas aeruginosa. The lack of spread of P cepacia to siblings with cystic fibrosis, and the relative lack of inpatient contact between colonised and uncolonised patients suggest that cross infection is not the sole route whereby patients with cystic fibrosis become infected, but the possibility of cross infection cannot be excluded from our data. Three patients with P cepacia died, but two of these had shown appreciable respiratory deterioration before colonisation with P cepacia; there was no evidence of unexpected deterioration in the remainder or in the controls with P maltophilia. By 1990, the prevalence of P cepacia was 9/133 (7%) and that of P maltophilia was 13/133 (10%), but it was impossible to determine to what extent this increase was due to the introduction of the routine use of selective media. Further studies are required to establish whether patients with and without P cepacia should be segregated.