The Effect of Strict Segregation on Pseudomonas aeruginosa in Cystic Fibrosis Patients

Rosa van Mansfeld, Angelica de Vrankrijker, Roland Brimicombe, Harry Heijerman, Ferdinand Teding van Berkhout, Cristian Spitoni, Sanne Grave, Cornelis van der Ent, Tom Wolfs, Rob Willems, Marc Bonten

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Segregation of patients with cystic fibrosis (CF) was implemented to prevent chronic infection with epidemic Pseudomonas aeruginosa strains with presumed detrimental clinical effects, but its effectiveness has not been carefully evaluated.

METHODS: The effect of strict segregation on the incidence of P. aeruginosa infection in CF patients was investigated through longitudinal protocolized follow-up of respiratory tract infection before and after segregation. In two nested cross-sectional studies in 2007 and 2011 the P. aeruginosa population structure was investigated and clinical parameters were determined in patients with and without infection with the Dutch epidemic P. aeruginosa clone (ST406).

RESULTS: Of 784 included patients 315 and 382 were at risk for acquiring chronic P. aeruginosa infection before and after segregation. Acquisition rates were, respectively, 0.14 and 0.05 per 1,000 days at risk (HR: 0.66, 95% CI [0.2548-1.541]; p = 0.28). An exploratory subgroup analysis indicated lower acquisition after segregation in children < 15 years of age (HR: 0.43, 95% CI[0.21-0.95]; p = 0.04). P. aeruginosa population structure did not change after segregation and ST406 was not associated with lung function decline, death or lung transplantation.

CONCLUSIONS: Strict segregation was not associated with a statistically significant lower acquisition of chronic P. aeruginosa infection and ST406 was not associated with adverse clinical outcome. After segregation there were no new acquisitions of ST406. In an unplanned exploratory analysis chronic acquisition of P. aeruginosa was lower after implementation of segregation in patients under 15 years of age.

Original languageEnglish
Article numbere0157189
Pages (from-to)1-14
Number of pages14
JournalPLoS One
Volume11
Issue number6
DOIs
Publication statusPublished - 2016

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