Somayaji R, Waddell B, Workentine M L, Surette M G, Brager N P, Rabin H R, Parkins M D
Department of Medicine, The University of Calgary, Calgary, Canada.
Department of Microbiology, Immunology and Infectious Diseases, The University of Calgary, 3330 Hospital Drive, NW, Calgary, AB, Canada.
BMC Pulm Med. 2015 Nov 5;15:138. doi: 10.1186/s12890-015-0116-x.
Epidemic P. aeruginosa (ePA) infections are common in cystic fibrosis (CF) and have been associated with accelerated clinical decline. Factors associated with ePA are unclear, and evidence based infection control interventions are lacking.
We prospectively collect all bacterial pathogens from adult CF patients. We performed PA strain typing on retrospectively collected enrollment samples and recent isolates to identify patients infected with ePA. All patients attending our clinic were approached to complete a survey on infection control knowledge, beliefs and exposures. We analyzed responses of those with ePA relative to the entire cohort without ePA as well as those infected with unique strains of P. aeruginosa to assess for risk factors for ePA and differences in infection control knowledge, beliefs or behaviours.
Of 144 participants, 30 patients had ePA (two Liverpool epidemic strain, 28 Prairie epidemic strain), 83 % of which had established infection prior to transition to the adult clinic. Risk of concomitant infecting pathogens was no different between groups although, Staphylococcus aureus and non-tuberculous mycobacteria were less common in those with ePA. Patients with ePA were more likely to have attended CF-camp and have a history of CF fundraising. Patients with ePA did not differ with respect to beliefs regarding pathogens or transmission risk, except they believed indirect contact posed little risk. Furthermore, patients with ePA were more likely to continue to associate with others with CF despite extensive counselling. Use of peer-peer online networking was minimal in both groups.
Infections with ePA are closely linked to past exposures, now routinely discouraged. As socialization is the greatest risk factor for ePA, infection control strategies for ePA must focus on discouraging face-to-face interactions amongst CF patients. As peer support remains a desire amongst patients, investment in technologies and strategies that enable indirect communication and support are required.
流行性铜绿假单胞菌（ePA）感染在囊性纤维化（CF）患者中很常见，并与临床病情加速恶化有关。与ePA相关的因素尚不清楚，且缺乏基于证据的感染控制干预措施。
我们前瞻性地收集成年CF患者的所有细菌病原体。我们对回顾性收集的入组样本和近期分离株进行了PA菌株分型，以确定感染ePA的患者。我们联系了所有在我们诊所就诊的患者，让他们完成一项关于感染控制知识、信念和暴露情况的调查。我们分析了感染ePA的患者相对于整个未感染ePA队列以及感染独特铜绿假单胞菌菌株的患者的回答，以评估ePA的危险因素以及感染控制知识、信念或行为的差异。
在144名参与者中，30名患者感染了ePA（2例为利物浦流行株，28例为草原流行株），其中83%在转入成人诊所之前就已确诊感染。尽管金黄色葡萄球菌和非结核分枝杆菌在感染ePA的患者中不太常见，但两组之间合并感染病原体的风险没有差异。感染ePA的患者更有可能参加过CF夏令营并有CF筹款史。感染ePA的患者在关于病原体或传播风险的信念方面没有差异，只是他们认为间接接触造成的风险很小。此外，尽管接受了广泛的咨询，感染ePA的患者仍更有可能继续与其他CF患者交往。两组中使用点对点在线网络的情况都很少。
ePA感染与过去的接触密切相关，而现在这种接触通常是不被鼓励的。由于社交是ePA的最大危险因素，ePA的感染控制策略必须侧重于劝阻CF患者之间的面对面互动。由于患者仍然渴望同伴支持，需要投资于能够实现间接沟通和支持的技术和策略。
