Pegues D A, Carson L A, Tablan O C, FitzSimmons S C, Roman S B, Miller J M, Jarvis W R
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333.
J Pediatr. 1994 May;124(5 Pt 1):694-702. doi: 10.1016/s0022-3476(05)81357-5.
To assess the risk of acquisition of Pseudomonas cepacia by person-to-person transmission at cystic fibrosis summer camps, we conducted in 1990 a study at three camps attended by patients with cystic fibrosis who had P. cepacia infection and patients without P. cepacia infection but who were considered susceptible to infection. We obtained sputum or throat cultures from campers on their arrival at, weekly during, at the end of, and 14 to 30 days after camp. We compared the incidence of sputum conversion of patients at camp with that of patients outside camp by culturing specimens from noncamper control subjects with cystic fibrosis who were known not to be infected < or = 2 weeks before and 4 to 6 weeks after camp. We also determined the risk factors for P. cepacia acquisition by determining the relative risk of acquisition between campers who were exposed versus campers who were not exposed to campers known to be infected or to potential environmental sources of P. cepacia at camp. The ribotype of P. cepacia isolates from campers with sputum conversion was compared with that of isolates from other campers and from an environmental source. The cumulative incidence of sputum conversion during the study period was 6.1% (11/181) among campers compared with no incidence (0/92) among noncampers (p = 0.02, Fisher Exact Test). The incidence of sputum conversion at camp varied according to the prevalence of campers with known infection (p < 0.001, chi-square test for trend). The rate of sputum conversion was higher in the camp with longer duration (relative risk = 12.0; 95% confidence interval = 2.7 to 53.5). Ribotyping showed that P. cepacia isolates from all 11 campers with sputum conversion were identical or similar (1 to 2 band difference) to isolates of other P. cepacia-infected campers including co-converters. These results suggest that P. cepacia can be acquired by patients with cystic fibrosis who are attending summer camp for such patients, possibly through person-to-person transmission, and that the risk increases with the prevalence of P. cepacia-infected campers and the duration of camp.
为评估在囊性纤维化夏令营中通过人际传播获得洋葱伯克霍尔德菌的风险，我们于1990年在三个夏令营开展了一项研究，参加夏令营的有感染洋葱伯克霍尔德菌的囊性纤维化患者以及未感染但被认为易感染的囊性纤维化患者。我们在营员抵达时、夏令营期间每周、结束时以及结束后14至30天采集其痰液或咽喉培养物。通过培养已知在夏令营开始前≤2周以及结束后4至6周未感染的非营员囊性纤维化对照受试者的标本，我们比较了营内患者与营外患者痰液转化的发生率。我们还通过确定暴露于已知感染营员或营内潜在洋葱伯克霍尔德菌环境源的营员与未暴露营员之间获得感染的相对风险，来确定获得洋葱伯克霍尔德菌的风险因素。将痰液转化的营员分离出的洋葱伯克霍尔德菌核糖型与其他营员及环境源分离出的核糖型进行比较。研究期间营员痰液转化的累积发生率为6.1%（11/181），而非营员中无发生率（0/92）（p = 0.02，Fisher精确检验）。营内痰液转化的发生率根据已知感染营员的患病率而有所不同（p < 0.001，趋势卡方检验）。持续时间较长的夏令营中痰液转化的发生率较高（相对风险 = 12.0；95%置信区间 = 2.7至53.5）。核糖分型显示，所有11例痰液转化的营员分离出的洋葱伯克霍尔德菌与其他感染洋葱伯克霍尔德菌的营员（包括共同转化者）的分离株相同或相似（相差1至2条带）。这些结果表明，参加此类患者夏令营的囊性纤维化患者可能通过人际传播获得洋葱伯克霍尔德菌，且风险会随着感染洋葱伯克霍尔德菌的营员患病率以及夏令营持续时间的增加而升高。
