Cross-infection in cystic fibrosis: The knowledge and behaviour of adult patients

AbstractIntroductionThe knowledge and behaviour of adult patients with cystic fibrosis (CF) regarding cross-infection are ill understood.MethodsA questionnaire was designed to investigate this at the West Midlands Adult CF Centre.Results94 patients completed the questionnaire. 54%, 36% and 46% had “no idea” of the lifetime risk of contracting Burkholderia cepacia complex, epidemic strains of Pseudomonas aeruginosa, and MRSA, respectively. 25–33% did not know the consequences of infection with these bacteria. 35% mixed with other people with CF, 6.5% during physiotherapy or nebulizer use. Most respondents did not think quality of life was significantly linked with segregation from other patients with CF.ConclusionsAdults with CF, at least in the West Midlands, have poor knowledge of the risk and consequences of cross-infection. A significant proportion ignored advice not to mix with other patients, although segregation was not thought to impact upon quality of life. This suggests that more education about the risks of cross-infection would be beneficial

Weight gain during acute treatment of an initial pulmonary exacerbation is associated with a longer interval to the next exacerbation in adults with cystic fibrosis

Weight gain during treatment for a cystic fibrosis exacerbation http://ow.ly/f1zl30dU9AO

Pseudomonas aeruginosa quorum sensing molecules correlate with clinical status in cystic fibrosis

ABSTRACT Pseudomonas aeruginosa produces quorum sensing signal molecules that are potential biomarkers for infection. A prospective study of 60 cystic fibrosis patients with chronic P. aeruginosa, who required intravenous antibiotics for pulmonary exacerbations, was undertaken. Clinical measurements and biological samples were obtained at the start and end of the treatment period. Additional data were available for 29 of these patients when they were clinically stable. Cross-sectionally, quorum sensing signal molecules were detectable in the sputum, plasma and urine of 86%, 75% and 83% patients, respectively. They were positively correlated between the three biofluids. Positive correlations were observed for most quorum sensing signal molecules in sputum, plasma and urine, with quantitative measures of pulmonary P. aeruginosa load at the start of a pulmonary exacerbation. Plasma concentrations of 2-nonyl-4-hydroxy-quinoline (NHQ) were significantly higher at the start of a pulmonary exacerbation compared to clinical stability ( p<0.01). Following the administration of systemic antibiotics, plasma 2-heptyl-4-hydroxyquinoline ( p=0.02) and NHQ concentrations (p<0.01) decreased significantly. In conclusion, quorum sensing signal molecules are detectable in cystic fibrosis patients with pulmonary P. aeruginosa infection and are positively correlated with quantitative measures of P. aeruginosa. NHQ correlates with clinical status and has potential as a novel biomarker for P. aeruginosa infection

Cystic fibrosis papers of the year 2010-2011

This review is based upon a Medline search of the literature on cystic fibrosis for the latter half of 2010 onwards. The Medline search was carried out in September 2011 and also includes some references published after September 2011. This search revealed articles relating to approximately 482 paediatric studies and 419 adult studies with much overlap between the two groups. Taking into account the multidisciplinary nature of the audience for this symposium and also taking into account the topics in the rest of the programme for the day, a shortlist of 65 papers was then derived. A diversity of topics was clearly necessary and also a mixture of paediatric and adult publications, hence the following papers were chosen

Cross-sectional and longitudinal multilocus sequence typing of Pseudomonas aeruginosa in cystic fibrosis sputum samples

Multilocus sequence typing (MLST) is a genetic typing tool designed to provide information about the relatedness of isolates at the core genome level. The utility of MLST in regard to cystic fibrosis (CF)-related infection with Pseudomonas aeruginosa is unknown. The molecular clock speed of the MLST genes was studied using 219 colonies isolated longitudinally from 49 patients with CF. A cross-sectional study examining 27 to 46 colonies per sputum sample for samples from 16 patients was also undertaken. The molecular clock speed was estimated to be 2.05 x 10(-5) (upper 95% confidence limit) or 4.75 x 10(-6) (50% confidence limit) point mutations per nucleotide per year. In the cross-sectional study, 50% of patients were infected with more than one sequence type. There was evidence of point mutations, recombination events, and coinfection with epidemic and unique strains. A clonal complex that was highly genetically distinct from the rest of the P. aeruginosa population was identified. The MLST scheme uses genes with an appropriate clock speed and provides useful information about the genetic variation of P. aeruginosa within and between patients with CF

Association between hypermutator phenotype, clinical variables, mucoid phenotype, and antimicrobial resistance in Pseudomonas aeruginosa

The presence of hypermutator Pseudomonas aeruginosa was associated with poorer lung function in patients at the Adult West Midlands CF Unit. Mucoid isolates were more likely to be hypermutators. The presence of resistant mutant subpopulations was associated with hypermutator phenotype but was not good enough to be used as a test for this phenotype