title: Pseudomonas aeruginosa Acquisition in Cystic Fibrosis Patients in Context of Otorhinolaryngological Surgery or Dentist Attendance: Case Series and Discussion of Preventive Concepts.
abstract: Introduction. P. aeruginosa is the primary cause for pulmonary destruction and premature death in cystic fibrosis (CF). Therefore, prevention of airway colonization with the pathogen, ubiquitously present in water, is essential. Infection of CF patients with P. aeruginosa after dentist treatment was proven and dental unit waterlines were identified as source, suggesting prophylactic measures. For their almost regular sinonasal involvement, CF patients often require otorhinolaryngological (ORL) attendance. Despite some fields around ORL-procedures with comparable risk for acquisition of P. aeruginosa, such CF cases have not yet been reported. We present four CF patients, who primarily acquired P. aeruginosa around ORL surgery, and one around dentist treatment. Additionally, we discuss risks and preventive strategies for CF patients undergoing ORL-treatment. Perils include contact to pathogen-carriers in waiting rooms, instrumentation, suction, drilling, and flushing fluid, when droplets containing pathogens can be nebulized. Postsurgery mucosal damage and debridement impair sinonasal mucociliary clearance, facilitating pathogen proliferation and infestation. Therefore, sinonasal surgery and dentist treatment of CF patients without chronic P. aeruginosa colonization must be linked to repeated microbiological assessment. Further studies must elaborate whether all CF patients undergoing ORL-surgery require antipseudomonal prophylaxis, including nasal lavages containing antibiotics. Altogether, this underestimated risk requires structured prevention protocols.
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Jochen G
authors: JG
authors: Mainz
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Andrea
authors: A
authors: Gerber
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Michael
authors: M
authors: Lorenz
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Ruth
authors: R
authors: Michl
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Julia
authors: J
authors: Hentschel
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: Anika
authors: A
authors: Nader
authors: Cystic Fibrosis Center, Pediatric Pneumology, Jena University Hospital, 07740 Jena, Germany.
authors: James F
authors: JF
authors: Beck
authors: Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany.
authors: Mathias W
authors: MW
authors: Pletz
authors: Department of Otorhinolaryngology/Plastic Surgery, SRH Wald-Klinikum, 07548 Gera, Germany.
authors: Andreas H
authors: AH
authors: Mueller