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August 1994

Possible Nosocomial Transmission of Pseudomonas cepacia in Patients With Cystic Fibrosis

Author Affiliations
From the Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Pegues, Tablan, and Jarvis and Mss Carson and Clark), and the Section of Pediatric Pulmonology, St Christopher's Hospital for Children and Temple University School of Medicine, Philadelphia, Pa (Dr Schidlow).
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)