Cystic fibrosis patients at risk of pseudomonas cross-infection
Patients with cystic fibrosis (CF) are susceptible
to cross-infection with Pseudomonas aeruginosa, two studies suggest.
This finding leads to questions over whether patients should be segregated
according to Ps aeruginosa infection status.
Dr Andrew Jones, of the Manchester Adult CF Centre,
and colleagues confirmed the spread of a multiresistant strain of Ps
aeruginosa among patients attending the centre. Of 154 patients, 14
per cent were identified as being infected with a similar and unusual
epidemic strain. The patients did not have contact with each other outside
the CF centre.
The researchers also examined the strains of Ps
aeruginosa present in a group of 24 patients who had been segregated
from other CF patients for eight years because of the presence of another
infection.
These patients were treated at the same outpatient
clinic but on different days from other CF patients, and when they needed
to be admitted to hospital they were treated on separate wards. None was
identified as having the epidemic strain (Lancet 2001;358:
557).
In the second study, researchers found evidence
of superinfection with Ps aeruginosa in four patients (already
colonised by other strains) following inpatient stays at the Regional
Adult CF Unit in Liverpool. They comment that a policy of separating patients
according to whether or not they have
Ps aeruginosa infection will not prevent superinfection and may
even potentiate it by grouping together at-risk patients (ibid, p558).
At a recent symposium in London attended by health
professionals who specialise in CF management, opinion was divided over
whether patients with CF should be segregated according to Ps aeruginosa
infection status.
A total of 71 delegates participated in a vote to
determine opinion on whether segregation policies should be introduced.
Just over half (53 per cent) of the delegates were in favour, 29 per cent
were against and 18 per cent were undecided.
Professor Duncan Geddes, respiratory physician,
Royal Brompton and Harefield NHS Trust, said that there was a lack of
evidence supporting the use of segregation to limit the spread of infection.
Other problems with segregation included uncertainty of sputum culture
results until after clinic visits, financial cost, loss of flexibility
in the clinic and risk of stigmatisation.
Speaking in favour of segregation, Mrs Mary Dodd,
specialist physiotherapist, adult cystic fibrosis unit, Wythenshawe Hospital,
Manchester, pointed out that segregation policies were accepted practice
for other infections such as methicillin resistant Staphylococcus aureus
(MRSA) and Burkholderia cepacia.
A more detailed report of the meeting will be published
in Hospital Pharmacist in the early autumn.
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