Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis

Arch Pediatr Adolesc Med. 1994 Aug;148(8):805-12. doi: 10.1001/archpedi.1994.02170080035006.


Objective: To determine whether nosocomial transmission of Pseudomonas cepacia occurred at a hospital with endemic P cepacia infection of patients with cystic fibrosis.

Design: Two retrospective case-control studies.

Setting: A large pediatric cystic fibrosis center.

Participants: To assess risk factors for acquisition of P cepacia, 18 cases, defined as any patient with cystic fibrosis with first documented isolation of P cepacia in 1988 or 1989, were compared with 18 matched P cepacia-negative controls with cystic fibrosis. To assess potential modes of nosocomial P cepacia transmission, 14 cases with a hospitalization(s) between their last P cepacia-negative culture and first P cepacia-positive culture were compared with 14 hospitalized P cepacia-negative controls with cystic fibrosis.

Methods: Handwiping cultures (N = 68) and selective environmental cultures were performed.

Main results: Cases tended to be more likely than controls to have been hospitalized at the cystic fibrosis center in the 3 months before their first P cepacia-positive culture (P = .08). In addition, cases tended to be more likely than hospitalized controls with cystic fibrosis to have had a P cepacia-positive roommate (P = .06) before becoming colonized with P cepacia organisms. Pseudomonas cepacia was cultured from the hands of two individuals: a P cepacia-colonized patient who had just undergone chest physiotherapy and consequent coughing and the investigator who shook the P cepacia-positive patient's hand after the patient's procedure.

Conclusions: These results suggest that in this cystic fibrosis center, hospitalization is a risk factor for P cepacia acquisition and that person-to-person transmission of P cepacia may occur in the hospital via hand contact.

MeSH terms

  • Adolescent
  • Adult
  • Bacterial Typing Techniques
  • Burkholderia cepacia* / classification
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cross Infection / epidemiology
  • Cross Infection / transmission*
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / therapy
  • Female
  • Hand / microbiology
  • Hand Disinfection
  • Hospitals, Pediatric
  • Humans
  • Incidence
  • Infant
  • Infection Control
  • Male
  • Matched-Pair Analysis
  • Philadelphia
  • Proportional Hazards Models
  • Pseudomonas Infections / epidemiology
  • Pseudomonas Infections / transmission*
  • Risk Factors
  • Severity of Illness Index
  • Time Factors