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Journal of Clinical Microbiology, May 2003, p. 2266-2267, Vol. 41, No. 5
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.5.2266-2267.2003

LETTER TO THE EDITOR

Evidence for Spread of a Clonal Strain of Pseudomonas aeruginosa among Cystic Fibrosis Clinics

	LETTER

Top Letter References

Using a combination of pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA assays, we previously identified a dominant clone (pulsotype I) of P. aeruginosa affecting 55% of patients capable of expectorating a sputum sample in a large pediatric/adolescent CF clinic in Melbourne (2). This strain has been shown to be genetically distinct from the epidemic strains found in the United Kingdom in Liverpool (8) and Manchester (6).

Subsequent screening using only PFGE (1) has identified pulsotype I as being the dominant strain in a large adult CF clinic 800 km away in Sydney. Thus far, 107 P. aeruginosa isolates from 32 patients have been tested. Sixteen (50%) of these patients have been identified as carrying pulsotype I. In addition, three of eight (38%) patients thus far tested at a Sydney pediatric CF center have also been shown to carry pulsotype I.

Eight (five adults, three pediatric patients) of 100 patients tested a further 1,000 km away in Brisbane (i.e., 1,800 km north of the original site) have also been shown to carry pulsotype I, although this was not the dominant strain at these centers. Four of these patients are known to have relocated from Sydney. No association with patients from either Sydney or Melbourne could be identified for the remaining patients.

Exchange of representative samples between the laboratories at the three clinics has confirmed the presence of pulsotype I in each of the centers. In general, pulsotype I exhibits multiple antibiotic resistance and frequently has a mucoid phenotype. No definite association with increased virulence has been established.

Previously it had been thought that patients with CF were generally infected for prolonged periods by unique lineages of environmentally acquired P. aeruginosa (7). More recent studies have identified dominant or hypertransmissible strains within a single clinic setting (2-6, 8, 9).

This is the first report of the same strain of P. aeruginosa being identified in patients from five CF clinics in three geographically dispersed regions separated by large distances. In three of these clinics, pulsotype I has been found to be the dominant strain, while preliminary data from a fourth pediatric center suggest that it may also be the dominant strain at that site.

Despite extensive environmental testing both within and outside of the hospital environments, we have been unable to identify any environmental or nosocomial source of pulsotype I.

The isolation of the same pulsotype from several CF clinics separated by large distances, its dominance (approximately 50% of patients) in a number of these clinics, and the failure to isolate this pulsotype from either the hospital or external environment are strongly indicative of P. aeruginosa being transmissible from patient to patient.

This suggests that P. aeruginosa cross-infection may be more common than previously believed. We recommend more widespread use of molecular surveillance for P. aeruginosa in large CF clinics. If cross-infection is shown to be present, then cohort segregation of patients harboring P. aeruginosa and those that are not, as well as patients with different strains of P. aeruginosa, may be advisable.

	ACKNOWLEDGMENTS

 
This work was supported by the U.S. Cystic Fibrosis Foundation, Royal Children's Hospital Foundation, and Australian Cystic Fibrosis Research Trust.

	REFERENCES

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1. Anthony, M., B. Rose, M. B. Pegler, M. Elkins, H. Service, K. Thamotharampillai, J. Watson, M. Robinson, P. Bye, J. Merlino, and C. Harbour. 2002. Genetic analysis of Pseudomonas aeruginosa isolates from the sputa of Australian adult cystic fibrosis patients. J. Clin. Microbiol. 40:2772-2778.[Abstract/Free Full Text]
2. Armstrong, D. S., G. M. Nixon, R. Carzino, A. Bigham, J. B. Carlin, R. M. Robins-Browne, and K. Grimwood. 2002. Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic. Am. J. Respir. Crit. Care Med. 166:983-987.[Abstract/Free Full Text]
3. Cheng, K., R. L. Smyth, J. R. Govan, C. Doherty, C. Winstanley, N. Denning, D. P. Heaf, H. van Saene, and C. A. Hart. 1996. Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet 348:639-642.[CrossRef][Medline]
4. Denton, M., K. Kerr, L. Mooney, V. Keer, A. Rajgopal, K. Brownlee, P. Arundel, and S. Conway. 2002. Transmission of colistin-resistant Pseudomonas aeruginosa between patients attending a pediatric cystic fibrosis center. Pediatr. Pulmonol. 34:257-261.[CrossRef][Medline]
5. Hunfeld, K. P., C. Schmidt, B. Krackhardt, H. G. Posselt, J. Bargon, Y. Yahaf, V. Schafer, V. Brade, and T. A. Wichelhaus. 2000. Risk of Pseudomonas aeruginosa cross-colonisation in patients with cystic fibrosis within a holiday camp—a molecular-epidemiological study. Wien Klin. Wochenschr. 112:329-333.[Medline]
6. Jones, A. M., A. K. Webb, J. R. Govan, C. A. Hart, and M. J. Walshaw. 2002. Pseudomonas aeruginosa cross-infection in cystic fibrosis. Lancet 359:527-528.[Medline]
7. Mahenthiralingam, E., M. E. Campbell, J. Foster, J. S. Lam, and D. P. Speert. 1996. Random amplified polymorphic DNA typing of Pseudomonas aeruginosa isolates recovered from patients with cystic fibrosis. J. Clin. Microbiol. 34:1129-1135.[Abstract]
8. McCallum, S. J., J. Corkill, M. Gallagher, M. J. Ledson, C. A. Hart, and M. J. Walshaw. 2001. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P. aeruginosa. Lancet 358:558-560.[CrossRef][Medline]
9. Pellegrino, F. L., L. M. Teixeira, M. da Gloria Siqueira Carvalho, S. Aranha Nouer, M. Pinto De Oliveira, J. L. Mello Sampaio, A. D'Avila Freitas, A. L. P. Ferreira, E. de Lourdes Teixeira Amorim, L. W. Riley, and B. M. Moreira. 2002. Occurrence of a multidrug-resistant Pseudomonas aeruginosa clone in different hospitals in Rio de Janeiro, Brazil. J. Clin. Microbiol. 40:2420-2424.[Abstract/Free Full Text]

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