The Effect of Strict Segregation on Pseudomonas aeruginosa in Cystic Fibrosis Patients.
BACKGROUND
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.
Department of Medical Microbiology, UMCU, Utrecht, The Netherlands.
Rosa
R
van Mansfeld
Department of Pediatric Pulmonary Diseases, UMCU, Utrecht, The Netherlands.
Angelica
A
de Vrankrijker
Department of Medical Microbiology, Haga Teaching Hospital, The Hague, The Netherlands.
Roland
R
Brimicombe
Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands.
Harry
H
Heijerman
Department of Pulmonology, UMCU, Utrecht, The Netherlands.
Ferdinand
F
Teding van Berkhout
Department of Mathematics, Utrecht University, Utrecht, The Netherlands.
Cristian
C
Spitoni
Department of Medical Microbiology, UMCU, Utrecht, The Netherlands.
Sanne
S
Grave
Department of Pediatric Pulmonary Diseases, UMCU, Utrecht, The Netherlands.
Cornelis
C
van der Ent
Department of Pediatric Infectious Diseases, UMCU, Utrecht, The Netherlands.
Tom
T
Wolfs
Department of Medical Microbiology, UMCU, Utrecht, The Netherlands.
Rob
R
Willems
Department of Medical Microbiology, UMCU, Utrecht, The Netherlands.|Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Marc
M
Bonten
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010356:Patient Isolation; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000517:prevention & control; D011550:Pseudomonas aeruginosa