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August 1994

Possible Nosocomial Transmission of Pseudomonas cepacia in Patients With Cystic Fibrosis

Arch Pediatr Adolesc Med. 1994;148(8):805-812. 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.(Arch Pediatr Adolesc Med. 1994;148:805-812)