Infection prevention and control in cystic fibrosis.

PURPOSE OF REVIEW

This review will discuss recent studies of the virulence of cystic fibrosis (CF) pathogens, including epidemic strains, a more complex understanding of droplet transmission, bacterial contamination of CF clinics, and identifying and overcoming barriers to implementation of infection control guidelines.

RECENT FINDINGS

Both morbidity and mortality are associated with methicillin-resistant Staphylococcus aureus (MRSA). Thus, clinicians are attempting eradication strategies for MRSA using combinations of oral, aerosolized, intravenous, and topical antibiotics, with some success. However, household contacts may be colonized with MRSA, which can impact the durability of eradication. Epidemic strains of Pseudomonas aeruginosa are also associated with increased morbidity and mortality and some clones are detected in CF patients throughout the world presumably due to social networks among patients. Recent experimental and clinical data have suggested that CF patients can generate droplet nuclei in the respirable range and that infectious particles can be cultured from room air minutes to hours after patients have left.

SUMMARY

Although these observations regarding droplet nuclei have not been linked to transmission, they do challenge the safety of the '3-foot rule' and suggest the potential role of masks. Additional research is needed to develop strategies to improve infection control practices among healthcare professionals, CF patients, and families.