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Pseudomonas cepacia colonization in patients with cystic fibrosis: risk factors and clinical outcome
Insights
Pseudomonas cepacia colonization in cystic fibrosis (CF) patients was endemic, with 45% of colonized individuals dying. Severe CF and having a sibling with CF and P. cepacia were key risk factors, leading to poorer outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Pseudomonas cepacia (P. cepacia) poses a significant threat to individuals with cystic fibrosis (CF).
- Understanding the epidemiology and risk factors for P. cepacia colonization in CF patients is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, risk factors, and clinical outcomes associated with P. cepacia respiratory tract colonization in cystic fibrosis patients.
- To determine the transmission patterns and potential sources of P. cepacia within a CF center.
Main Methods:
- A retrospective study analyzing data from 38 CF patients with P. cepacia colonization between 1979 and 1983.
- Case-control studies were conducted to identify risk factors for colonization.
- Environmental and microbiologic investigations were performed to assess transmission routes.
Main Results:
- The yearly incidence of P. cepacia colonization ranged from 1.3% to 6.1%, indicating an endemic presence.
- Significant risk factors included severe underlying CF, aminoglycoside use, and having a sibling with CF and P. cepacia colonization.
- Colonized patients experienced longer hospitalizations and higher mortality rates compared to non-colonized CF patients.
Conclusions:
- P. cepacia colonization in CF patients appears to be endemic within healthcare settings.
- Severe CF disease and specific patient/family factors increase the risk of colonization.
- P. cepacia colonization is strongly associated with adverse clinical outcomes, including increased mortality in CF patients.
Abstract:
During the period of 1979 to 1983, 38 patients with cystic fibrosis (CF) at the CF center of St. Christopher's Hospital for Children in Pennsylvania developed respiratory tract colonization with Pseudomonas cepacia. Seventeen (45%) of the patients with colonization died. Yearly incidence rates of P. cepacia colonization fluctuated between 1.3% and 6.1%, suggesting an endemic phenomenon. Case-control studies showed that severe underlying CF, use of aminoglycosides, and having a sibling with CF and P. cepacia colonization were significant risk factors for P. cepacia colonization. Once colonized with P. cepacia, patients with CF were likely to be hospitalized longer (P = 0.008) and to die sooner (P = 0.0001) than control patients with CF. Environmental and microbiologic studies did not identify a common source or mode of transmission of P. cepacia among patients. The results of this investigation suggest that P. cepacia colonization of patients with CF was endemic in the hospital, occurred more frequently in those with severe disease, and was associated with adverse clinical outcome.