Hygienemaßnahmen für Patienten mit Cystischer Fibrose

Zusammenfassung

Hintergrund: Infektionen der Atemwege verschlechtern signifikant die Prognose von Patienten mit Cystischer Fibrose. Methode: Um Empfehlungen zu Hygienemaßnahmen von mit B. cepacia spp., P. aeruginosa, S. maltophilia oder Alcaligenes spp. besiedelten CF-Patienten geben zu können, wurde ein systematisches Review durchgeführt. Dabei wurden 64 Studien zu Transmissionen dieser Erreger bzw. Empfehlungen zur Isolation betroffener Patienten ausgewertet und hinsichtlich Evidenz und Qualität bewertet. Ergebnisse: In 35 von 36 Studien wird die Isolation B. cepacia spp. besiedelter Patienten empfohlen. In 21 von 25 Studien wird auch die Isolation von mit P. aeruginosa besiedelten Patienten empfohlen. Mit S. maltophilia und Alcaligenes spp. beschäftigen sich nur 5 Studien. Schlussfolgerungen: a) Patienten mit B. cepacia spp. sind immer in Einzelzimmern zu isolieren. b) P. aeruginosa-besiedelte CF-Patienten sollen von nicht besiedelten CF-Patienten getrennt werden. c) Patienten, deren P. aeruginosa, S. maltophila oder Alcaligenes spp. sogar multiresistent sind, sollen sich außerdem auch kein Zimmer mit immunsupprimierten Patienten teilen und sind auch auf Intensivstationen stets zu isolieren.

Abstract

Background: Respiratory tract infections significantly contribute to morbidity and mortality of cystic fibrosis patients. Methods: We conducted a systematic literature review (Pubmed 01/1966 up to 09/2003) in order to present recommendations for the isolation of CF patients colonized with Burkholderia cepacia spp., Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Alcaligenes spp. Evidence and quality of 64 publications dealing with pathogen transmission or isolation measurements of colonized patients were evaluated. Results: B. cepacia spp. was dealt most often with and 35 of 36 authors recommended the isolation of patients colonized with this pathogen. Isolation of patients colonized with P. aeruginosa was proposed by 21 of 25 authors. Only 5 studies concerned S. maltophilia or Alcaligenes spp. Conclusions: A) B. cepacia spp. colonized patients need to get a single room for their own. B) P. aeruginosa colonized CF patients should be separated from non-colonized CF patients. C) Patients harbouring even multi drug resistant P. aeruginosa, S. maltophilia or Alcaligenes spp. may not share their room with immunocompromised patients and should also be isolated when treated in intensive care units.

Literatur

• 1 Pseudomonas cepacia at summer camps for persons with cystic fibrosis.  MMWR Morb Mortal Wkly Rep. 1993;  42 456-459
• 2 Agodi A, Barchitta M, Giannino V. et al . Burkholderia cepacia complex in cystic fibrosis and non-cystic fibrosis patients: identification of a cluster of epidemic lineages.  J Hosp Infect. 2002;  50 188-195
• 3 Agodi A, Mahenthiralingam E, Barchetta M. et al . Burkholderia cepacia complex infection in Italian patients with cystic fibrosis: prevalence, epidemiology, and genomovar status.  J Clin Microbiol. 2001;  39 2891-2896
• 4 Agodi A, Sciacca A, Campanile F. et al . Molecular epidemiology of Pseudomonas aeruginosa from cystic fibrosis in Sicily: genome macrorestriction analysis and rapid PCR-ribotyping.  New Microbiol. 2000;  23 319-327
• 5 Alonso A, Campanario E, Martinez J L. Emergence of multidrug-resistant mutants is increased under antibiotic selective pressure in Pseudomonas aeruginosa.  Microbiology. 1999;  145 (Pt 10) 2857-2862
• 6 Amalfitano G, Tonolli E, Favari F. et al . Field inversion gel electrophoresis on Pseudomonas cepacia strains isolated from cystic fibrosis patients.  Eur J Epidemiol. 1996;  12 149-153
• 7 Armstrong D S, Nixon G M, Carzino R. et al . Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic.  Am J Respir Crit Care Med. 2002;  166 983-987
• 8 Bergmans D C, Bonten M J, Tiel F H van. et al . Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit.  Thorax. 1998;  53 1053-1058
• 9 Bertrand X, Thouverez M, Talon D. et al . Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units.  Intensive Care Med. 2001;  27 1263-1268
• 10 Bevivino A, Dalmastri C, Tabacchini S. et al . Burkholderia cepacia complex bacteria from clinical and environmental sources in Italy: genomovar status and distribution of traits related to virulence and transmissibility.  J Clin Microbiol. 2002;  40 846-851
• 11 Bingen E H, Weber M, Derelle J. et al . Arbitrarily primed polymerase chain reaction as a rapid method to differentiate crossed from independent Pseudomonas cepacia infections in cystic fibrosis patients.  J Clin Microbiol. 1993;  31 2589-2593
• 12 Bosshammer J, Fiedler B, Gudowius P. et al . Comparative hygienic surveillance of contamination with pseudomonads in a cystic fibrosis ward over a 4-year period.  J Hosp Infect. 1995;  31 261-274
• 13 Botzenhart K, Wolz C, Doring G. Cross-colonization and routes of infection assessed with a DNA probe.  Antibiot Chemother. 1991;  44 8-12
• 14 Burns J L, Saiman L. Burkholderia cepacia infections in cystic fibrosis.  Pediatr Infect Dis J. 1999;  18 155-156
• 15 Cazzola G, Amalfitano G, Tonolli E. et al . Burkholderia (Pseudomonas) cepacia epidemiology in a cystic fibrosis population: a genome finger-printing study.  Acta Paediatr. 1996;  85 554-557
• 16 Chaparro C, Maurer J, Gutierrez C. et al . Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation.  Am J Respir Crit Care Med. 2001;  163 43-48
• 17 Chen J S, Witzmann K A, Spilker T. et al . Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis.  J Pediatr. 2001;  139 643-649
• 18 Cheng K, Smyth R L, Govan J R. et al . Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic.  Lancet. 1996;  348 639-642
• 19 Ciofu O, Jensen T, Pressler T. et al . Meropenem in cystic fibrosis patients infected with resistant Pseudomonas aeruginosa or Burkholderia cepacia and with hypersensitivity to beta-lactam antibiotics.  Clin Microbiol Infect. 1996;  2 91-98
• 20 Clode F E, Kaufmann M E, Malnick H. et al . Distribution of genes encoding putative transmissibility factors among epidemic and nonepidemic strains of Burkholderia cepacia from cystic fibrosis patients in the United Kingdom.  J Clin Microbiol. 2000;  38 1763-1766
• 21 Coenye T, LiPuma J J, Henry D. et al . Burkholderia cepacia genomovar VI, a new member of the Burkholderia cepacia complex isolated from cystic fibrosis patients.  Int J Syst Evol Microbiol. 2001;  51 271-279
• 22 Coenye T, Mahenthiralingam E, Henry D. et al . Burkholderia ambifaria sp. nov., a novel member of the Burkholderia cepacia complex including biocontrol and cystic fibrosis-related isolates.  Int J Syst Evol Microbiol. 2001;  51 1481-1490
• 23 Coenye T, Vandamme P, Govan J R. et al . Taxonomy and identification of the Burkholderia cepacia complex.  J Clin Microbiol. 2001;  39 3427-3436
• 24 Denton M, Kerr K, Mooney L. et al . Transmission of colistin-resistant Pseudomonas aeruginosa between patients attending a pediatric cystic fibrosis center.  Pediatr Pulmonol. 2002;  34 257-261
• 25 Denton M, Todd N J, Kerr K G. et al . Molecular epidemiology of Stenotrophomonas maltophilia isolated from clinical specimens from patients with cystic fibrosis and associated environmental samples.  J Clin Microbiol. 1998;  36 1953-1958
• 26 Deretic V, Schurr M J, Yu H. Pseudomonas aeruginosa, mucoidy and the chronic infection phenotype in cystic fibrosis.  Trends Microbiol. 1995;  3 351-356
• 27 Doring G, Jansen S, Noll H. et al . Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward.  Pediatr Pulmonol. 1996;  21 90-100
• 28 Drabick J A, Gracely E J, Heidecker G J. et al . Survival of Burkholderia cepacia on environmental surfaces.  J Hosp Infect. 1996;  32 267-276
• 29 Duff A J. Psychological consequences of segregation resulting from chronic Burkholderia cepacia infection in adults with CF.  Thorax. 2002;  57 756-758
• 30 Dunne Jr W M, Maisch S. Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction.  Clin Infect Dis. 1995;  20 836-841
• 31 Emmanouilidou-Arseni A, Koumentakou I. Viability of Pseudomonas aeruginosa.  J Bacteriol. 1964;  87 1253
• 32 Fegan M, Francis P, Hayward A C. et al . Phenotypic conversion of Pseudomonas aeruginosa in cystic fibrosis.  J Clin Microbiol. 1990;  28 1143-1146
• 33 Fegan M, Francis P, Hayward A C. et al . Heterogeneity, persistence, and distribution of Pseudomonas aeruginosa genotypes in cystic fibrosis patients.  J Clin Microbiol. 1991;  29 2151-2157
• 34 Fiore A, Laevens S, Bevivino A. et al . Burkholderia cepacia complex: distribution of genomovars among isolates from the maize rhizosphere in Italy.  Environ Microbiol. 2001;  3 137-143
• 35 Fisher M C, LiPuma J J, Dasen S E. et al . Source of Pseudomonas cepacia: ribotyping of isolates from patients and from the environment.  J Pediatr. 1993;  123 745-747
• 36 Gillis M, Van T V, Bardin R. et al . Polyphasic taxonomy in the genus Burkholderia leading to an emended description of the genus and proposition of Burkholderia vietnamiensis sp. nov. for N2-fixing isolates from rice in Vietnam.  Int J Syst Bacteriol. 1995;  45 274-289
• 37 Govan J R. Burkholderia cepacia in cystic fibrosis.  N Engl J Med. 1995;  332 819-820
• 38 Govan J R, Brown P H, Maddison J. et al . Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis.  Lancet. 1993;  342 15-19
• 39 Govan J R, Deretic V. Microbial pathogenesis in cystic fibrosis: mucoid Pseudomonas aeruginosa and Burkholderia cepacia.  Microbiol Rev. 1996;  60 539-574
• 40 Grothues D, Koopmann U, Hardt H von der. et al . Genome fingerprinting of Pseudomonas aeruginosa indicates colonization of cystic fibrosis siblings with closely related strains.  J Clin Microbiol. 1988;  26 1973-1977
• 41 Gundermann K O. [Life-span of bacterial strains in dust as influenced by various degrees of air humidity].  Zentralbl Bakteriol [Orig.B]. 1972;  156 422-429
• 42 Heath D G, Hohneker K, Carriker C. et al . Six-year molecular analysis of Burkholderia cepacia complex isolates among cystic fibrosis patients at a referral center for lung transplantation.  J Clin Microbiol. 2002;  40 1188-1193
• 43 Holmes A, Nolan R, Taylor R. et al . An epidemic of burkholderia cepacia transmitted between patients with and without cystic fibrosis.  J Infect Dis. 1999;  179 1197-1205
• 44 Hoogkamp-Korstanje J A, Meis J F, Kissing J. et al . Risk of cross-colonization and infection by Pseudomonas aeruginosa in a holiday camp for cystic fibrosis patients.  J Clin Microbiol. 1995;  33 572-575
• 45 Hunfeld K P, Schmidt C, Krackhardt B. et al . Risk of Pseudomonas aeruginosa cross-colonisation in patients with cystic fibrosis within a holiday camp - a molecular-epidemiological study.  Wien Klin Wochenschr. 2000;  112 329-333
• 46 Jones A M, Govan J R, Doherty C J. et al . Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic.  Lancet. 2001;  358 557-558
• 47 Jones A M, Govan J R, Doherty C J. et al . Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak.  Thorax. 2003;  58 525-527
• 48 Krzewinski J W, Nguyen C D, Foster J M. et al . Use of random amplified polymorphic DNA PCR to examine epidemiology of Stenotrophomonas maltophilia and Achromobacter (Alcaligenes) xylosoxidans from patients with cystic fibrosis.  J Clin Microbiol. 2001;  39 3597-3602
• 49 Kulich M, Rosenfeld M, Goss C H. et al . Improved survival among young patients with cystic fibrosis.  J Pediatr. 2003;  142 631-636
• 50 Ledson M J, Gallagher M J, Corkill J E. et al . Cross infection between cystic fibrosis patients colonised with Burkholderia cepacia.  Thorax. 1998;  53 432-436
• 51 Ledson M J, Gallagher M J, Walshaw M J. Chronic Burkholderia cepacia bronchiectasis in a non-cystic fibrosis individual.  Thorax. 1998;  53 430-432
• 52 LiPuma J J, Dasen S E, Nielson D W. et al . Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis.  Lancet. 1990;  336 1094-1096
• 53 LiPuma J J, Marks-Austin K A, Holsclaw Jr D S. et al . Inapparent transmission of Pseudomonas (Burkholderia) cepacia among patients with cystic fibrosis.  Pediatr Infect Dis J. 1994;  13 716-719
• 54 LiPuma J J, Mortensen J E, Dasen S E. et al . Ribotype analysis of Pseudomonas cepacia from cystic fibrosis treatment centers.  J Pediatr. 1988;  113 859-862
• 55 LiPuma J J, Stull T L. Burkholderia cepacia in cystic fibrosis.  N Engl J Med. 1995;  332 820-821
• 56 Mahenthiralingam E, Vandamme P, Campbell M E. et al . Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans.  Clin Infect Dis. 2001;  33 1469-1475
• 57 Martin C, Ichou M A, Massicot P. et al . Genetic diversity of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis revealed by restriction fragment length polymorphism of the rRNA gene region.  J Clin Microbiol. 1995;  33 1461-1466
• 58 McCallum S J, Corkill J, Gallagher M. et al . Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa.  Lancet. 2001;  358 558-560
• 59 McCallum S J, Gallagher M J, Corkill J E. et al . Spread of an epidemic Pseudomonas aeruginosa strain from a patient with cystic fibrosis (CF) to non-CF relatives.  Thorax. 2002;  57 559-560
• 60 McDade J J, Hall M. Survival of gram negative bacteria in the evironment.  Am J Hyg. 1964;  80 192-204
• 61 Millar-Jones L, Ryley H C, Paull A. et al . Transmission and prevalence of Burkholderia cepacia in Welsh cystic fibrosis patients.  Respir Med. 1998;  92 178-183
• 62 Miyawaki H, Fujita J, Takigawa K. et al . Investigation of nosocomial respiratory infection due to Pseudomonas cepacia by arbitrarily primed polymerase chain reaction.  Diagn Microbiol Infect Dis. 1995;  23 77-83
• 63 Moissenet D, Baculard A, Valcin M. et al . Colonization by Alcaligenes xylosoxidans in children with cystic fibrosis: a retrospective clinical study conducted by means of molecular epidemiological investigation.  Clin Infect Dis. 1997;  24 274-275
• 64 Muhdi K, Edenborough F P, Gumery L. et al . Outcome for patients colonised with Burkholderia cepacia in a Birmingham adult cystic fibrosis clinic and the end of an epidemic.  Thorax. 1996;  51 374-377
• 65 Nelson J W, Doherty C J, Brown P H. et al . Pseudomonas cepacia in inpatients with cystic fibrosis.  Lancet. 1991;  338 1525
• 66 Ojeniyi B, Frederiksen B, Hoiby N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp.  Pediatr Pulmonol. 2000;  29 177-181
• 67 Paul M L, Pegler M A, Benn R A. Molecular epidemiology of Burkholderia cepacia in two Australian cystic fibrosis centres.  J Hosp Infect. 1998;  38 19-26
• 68 Pegues D A, Carson L A, Tablan O C. et al . Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. Summer Camp Study Group.  J Pediatr. 1994;  124 694-702
• 69 Pegues D A, Schidlow D V, Tablan O C. et al . Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis.  Arch Pediatr Adolesc Med. 1994;  148 805-812
• 70 Rajan S, Saiman L. Pulmonary infections in patients with cystic fibrosis.  Semin Respir Infect. 2002;  17 47-56
• 71 Renders N, Belkum A van, Barth A. et al . Typing of Pseudomonas aeruginosa strains from patients with cystic fibrosis: phenotyping versus genotyping.  Clin Microbiol Infect. 1996;  1 261-265
• 72 Revets H, Vandamme P, Zeebroeck A van. et al . Burkholderia (Pseudomonas) cepacia and cystic fibrosis: the epidemiology in Belgium.  Acta Clin Belg. 1996;  51 222-230
• 73 Rozee K R, Haase D, Macdonald N E. et al . Comparison by extended ribotyping of Pseudomonas cepacia isolated from cystic fibrosis patients with acute and chronic infections.  Diagn Microbiol Infect Dis. 1994;  20 181-186
• 74 Ryley H C, Ojeniyi B, Hoiby N. et al . Lack of evidence of nosocomial cross-infection by Burkholderia cepacia among Danish cystic fibrosis patients.  Eur J Clin Microbiol Infect Dis. 1996;  15 755-758
• 75 Saiman L, Siegel J. Infection control recommendations for patients with cystic fibrosis: Microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission.  Am J Infect Control. 2003;  31 S1-62
• 76 Shreve M R, Johnson S J, Milla C E. et al . PCR ribotyping and endonuclease subtyping in the epidemiology of Burkholderia cepacia infection.  Am J Respir Crit Care Med. 1997;  155 984-989
• 77 Siddiqui A H, Mulligan M E, Mahenthiralingam E. et al . An episodic outbreak of genetically related Burkholderia cepacia among non-cystic fibrosis patients at a university hospital.  Infect Control Hosp Epidemiol. 2001;  22 419-422
• 78 Silva Filho L V, Levi J E, Bento C N. et al . Molecular epidemiology of Pseudomonas aeruginosa infections in a cystic fibrosis outpatient clinic.  J Med Microbiol. 2001;  50 261-267
• 79 Smith D L, Gumery L B, Smith E G. et al . Epidemic of Pseudomonas cepacia in an adult cystic fibrosis unit: evidence of person-to-person transmission.  J Clin Microbiol. 1993;  31 3017-3022
• 80 Smith D L, Smith E G, Gumery L B. et al . Epidemiology of Pseudomonas aeruginosa infection in cystic fibrosis and the use of strain genotyping.  J Infect. 1993;  26 325-331
• 81 Smith D L, Smith E G, Pitt T L. et al . Regional microbiology of the cystic fibrosis lung: a post-mortem study in adults.  J Infect. 1998;  37 41-43
• 82 Speert D P, Campbell M E, Henry D A. et al . Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada.  Am J Respir Crit Care Med. 2002;  166 988-993
• 83 Speert D P, Henry D, Vandamme P. et al . Epidemiology of Burkholderia cepacia complex in patients with cystic fibrosis, Canada.  Emerg Infect Dis. 2002;  8 181-187
• 84 Spencker F B, Haupt S, Claros M C. et al . Epidemiologic characterization of Pseudomonas aeruginosa in patients with cystic fibrosis.  Clin Microbiol Infect. 2000;  6 600-607
• 85 Steinbach S, Sun L, Jiang R Z. et al . Transmissibility of Pseudomonas cepacia infection in clinic patients and lung-transplant recipients with cystic fibrosis.  N Engl J Med. 1994;  331 981-987
• 86 Sun L, Jiang R Z, Steinbach S. et al . The emergence of a highly transmissible lineage of cbl+ Pseudomonas (Burkholderia) cepacia causing CF centre epidemics in North America and Britain.  Nat Med. 1995;  1 661-666
• 87 Taccetti G, Campana S. Microbiologic data overview of Italian cystic fibrosis patients.  Eur J Epidemiol. 1997;  13 323-327
• 88 Taylor R F, Dalla C L, Kaufmann M E. et al . Pseudomonas cepacia pulmonary infection in adults with cystic fibrosis: is nosocomial acquisition occurring?.  J Hosp Infect. 1992;  21 199-204
• 89 Tubbs D, Lenney W, Alcock P. et al . Pseudomonas aeruginosa in cystic fibrosis: cross-infection and the need for segregation.  Respir Med. 2001;  95 147-152
• 90 Tummler B, Bosshammer J, Breitenstein S. et al . Infections with Pseudomonas aeruginosa in patients with cystic fibrosis.  Behring Inst Mitt. 1997;  98 249-255
• 91 Tummler B, Koopmann U, Grothues D. et al . Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients.  J Clin Microbiol. 1991;  29 1265-1267
• 92 Valcin M, Moissenet D, Sardet A. et al . Pseudomonas (Burkholderia) cepacia in children with cystic fibrosis: epidemiological investigation by analysis or restriction fragment length polymorphism.  Pathol Biol (Paris). 1996;  44 442-446
• 93 Vandamme P, Henry D, Coenye T. et al . Burkholderia anthina sp. nov. and Burkholderia pyrrocinia, two additional Burkholderia cepacia complex bacteria, may confound results of new molecular diagnostic tools.  FEMS Immunol Med Microbiol. 2002;  33 143-149
• 94 Vandamme P, Holmes B, Coenye T. et al . Burkholderia cenocepacia sp. nov. - a new twist to an old story.  Res Microbiol. 2003;  154 91-96
• 95 Vandamme P, Holmes B, Vancanneyt M. et al . Occurrence of multiple genomovars of Burkholderia cepacia in cystic fibrosis patients and proposal of Burkholderia multivorans sp. nov.  Int J Syst Bacteriol. 1997;  47 1188-1200
• 96 Vandamme P, Mahenthiralingam E, Holmes B. et al . Identification and population structure of Burkholderia stabilis sp. nov. (formerly Burkholderia cepacia genomovar IV).  J Clin Microbiol. 2000;  38 1042-1047
• 97 Vu-Thien H, Moissenet D, Valcin M. et al . Molecular epidemiology of Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans in a cystic fibrosis center.  Eur J Clin Microbiol Infect Dis. 1996;  15 876-879
• 98 Walsh N M, Casano A A, Manangan L P. et al . Risk factors for Burkholderia cepacia complex colonization and infection among patients with cystic fibrosis.  J Pediatr. 2002;  141 512-517
• 99 Wolz C, Kiosz G, Ogle J W. et al . Pseudomonas aeruginosa cross-colonization and persistence in patients with cystic fibrosis. Use of a DNA probe.  Epidemiol Infect. 1989;  102 205-214
• 100 Zembrzuska-Sadkowska E, Sneum M, Ojeniyi B. et al . Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in the Danish Cystic Fibrosis Centre.  J Hosp Infect. 1995;  29 1-7