title: Case-control and vector studies of nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.
abstract: OBJECTIVE
  To examine factors associated with nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis.
  
  
  METHODS
  A retrospective case-control study of 5 patients with nosocomial acquisition of P cepacia versus 20 matched controls who failed to develop P cepacia infection. Selective handwashing, air sampling, and respiratory equipment sampling also were performed.
  
  
  METHODS
  A university hospital providing tertiary care to 95 adult cystic fibrosis patients.
  
  
  METHODS
  All patients are adults with known cystic fibrosis. Case definition required multiple negative sputum cultures for P cepacia prior to and during admission, with a positive sputum culture prior to discharge. Controls had negative sputum cultures for P cepacia prior to and throughout hospitalization. Controls were matched for age, gender, disease severity, and frequency of hospitalizations.
  
  
  RESULTS
  Factors associated with increased risk of nosocomial acquisition of P cepacia included receiving humidifier or nebulized treatments (60% versus 5%, p = .016, odds ratio = 28.5, 95% confidence interval = 1.93 to 420.58). Factors without significance included ward, room, teaching versus nonteaching status, use of steroids, sharing a hospital room with another cystic fibrosis patient, antibiotic use, presence of portocath in situ, or socializing with another individual with cystic fibrosis known to be P cepacia-positive. Air sampling studies failed to demonstrate aerosolization of P cepacia by coughing cystic fibrosis patients over a 1-hour sampling time. Handwashing studies failed to demonstrate P cepacia on hands of cystic fibrosis patients, nurses, or physiotherapists (before or after physiotherapy). Reservoirs from nebulizers consistently grew P cepacia following therapy.
  
  
  CONCLUSIONS
  Respiratory equipment may be an important source of nosocomial acquisition of P cepacia in adult cystic fibrosis patients.
authors.affiliation: Division of Infectious Disease, University Hospital, Vancouver, British Columbia, Canada.
authors.forename: D R
authors.initials: DR
authors.lastname: Burdge
authors.forename: E M
authors.initials: EM
authors.lastname: Nakielna
authors.forename: M A
authors.initials: MA
authors.lastname: Noble
mesh_terms: D000328:Adult; D000391:Air Microbiology; D016956:Burkholderia cepacia; D016022:Case-Control Studies; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission*; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology; D004197:Disease Reservoirs; D004866:Equipment Contamination; D006235:Hand Disinfection; D006785:Hospitals, University; D006801:Humans; D009330:Nebulizers and Vaporizers; D011552:Pseudomonas Infections / Q000382:microbiology / Q000635:transmission*; D012189:Retrospective Studies