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Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-to-Patient Transmission

Published online by Cambridge University Press:  02 January 2015

Lisa Saiman
Affiliation:
Department of Pediatrics, Columbia University, New York, New York
Jane Siegel
Affiliation:
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

Extract

Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-to-Patient Transmission updates, expands, and replaces the consensus statement, Microbiology and Infectious Disease in Cystic Fibrosis published in 1994. This consensus document presents background data and evidence-based recommendations for practices that are intended to decrease the risk of transmission of respiratory pathogens among CF patients from contaminated respiratory therapy equipment or the contaminated environment and thereby reduce the burden of respiratory illness. Included are recommendations applicable in the acute care hospital, ambulatory, home care, and selected non-healthcare settings. The target audience includes all healthcare workers who provide care to CF patients. Antimicrobial management is beyond the scope of this document.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Cystic Fibrosis Consensus Conference May 17-18, 1994. Microbiology and Infectious Disease in Cystic Fibrosis. Cystic Fibrosis Foundation; Volume V, Section 1:126.Google Scholar
2.Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17:5380.CrossRefGoogle ScholarPubMed
3.Cystic Fibrosis Foundation. Patient Registry 1995. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 1996.Google Scholar
4.Cystic Fibrosis Foundation. Patient Registry 1996. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 1997.Google Scholar
5.Cystic Fibrosis Foundation. Patient Registry 1997. In: Annual Report. Bethesda, MD; 1998.Google Scholar
6.Cystic Fibrosis Foundation. Patient Registry 1998. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 1999.Google Scholar
7.Cystic Fibrosis Foundation. Patient Registry 1999. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 2000.Google Scholar
8.Cystic Fibrosis Foundation. Patient Registry 2000. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 2001.Google Scholar
9.Cystic Fibrosis Foundation. Patient Registry 2001. In: Annual Report. Bethesda, MD: Cystic Fibrosis Foundation; 2002.Google Scholar
10.Burns, JL, Emerson, J, Stapp, JR, et al. Microbiology of sputum from patients at cystic fibrosis centers in the United States. Clin Infect Dis. 1998;27:158-63.Google Scholar
11.McMenamin, JD, Zaccone, TM, Coenye, T, Vandamme, P, LiPuma, JJ. Misidentification of Burkholderia cepacia in US cystic fibrosis treatment centers: an analysis of 1,051 recent sputum isolates. Chest. 2000;117:1661-5.CrossRefGoogle Scholar
12.Boyce, JM, Pittet, D. Hand hygiene and patient care: pursuing the Semmelweis legacy. The Lancet Infect Diseases. 2001;920.Google Scholar
13.Boyce, JM, Pittet, D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:145.Google ScholarPubMed
14.Rutala, WA, Weber, DJ. Principles of disinfecting patient-care items. In: Rutala, WA, ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:133149.Google Scholar
15.Rutala, WA, Weber, DJ, HICPAC. Guideline for disinfection and sterilization in healthcare facilities. In press.Google Scholar
16.Frederiksen, B, Koch, C, Hoiby, N. Antibiotic treatment of initial colonization with Pseudomonas aeruginosa postpones chronic infection and prevents deterioration of pulmonary function in cystic fibrosis. Pediatr Pulmonol. 1997;23:330-5.Google Scholar
17.Nixon, GM, Armstrong, DS, Carzino, R, et al. Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis. J Pediatr. 2001;138:699704.CrossRefGoogle ScholarPubMed
18.Ratjen, F, Doring, G, Nikolaizik, WH. Effect of inhaled tobramycin on early Pseudomonas aeruginosa colonisation in patients with cystic fibrosis. Lancet. 2001;358:983-4.Google Scholar
19.Burns, JL, Saiman, L, Whittier, S, et al. Comparison of two commercial systems (Vitek and MicroScan-WalkAway) for antimicrobial susceptibility testing of Pseudomonas aeruginosa isolates from cystic fibrosis patients. Diagn Microbiol Infect Dis. 2001;39:257–60.CrossRefGoogle ScholarPubMed
20.NCCLS. Performance Standards for Antimicrobial Susceptibility Testing; 11th Informational Supplement. Vol. 21, NCCLS document M100-S11. Wayne, PA: NCCLS, 2001.Google Scholar
21.Saiman, L, Burns, JL, Whittier, S, Krzewinski, J, Marshall, SA, Jones, RN. Evaluation of reference dilution test methods for antimicrobial susceptibility testing of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis. J Clin Microbiol. 1999;37:2987-91.CrossRefGoogle ScholarPubMed
22.Chen, JS, Witzmann, K, Spilker, T, Fink, R, LiPuma, JJ. Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis. J Pediatr. 2001;139:643-9.Google Scholar
23.IiPuma, JJ, Marks-Austin, KA, Holsclaw, DS Jr, Winnie, GB, Gilligan, PH, Stull, TL. Inapparent transmission of Pseudomonas (Burkholderia) cepacia among patients with cystic fibrosis. Pediatr Infect Dis J. 1994;13:716-9.Google Scholar
24.Mahenthiralingam, E, Campbell, ME, Foster, J, Lam, JS, Speert, DP. Random amplified polymorphic DNA typing of Pseudomonas aeruginosa isolates recovered from patients with cystic fibrosis1. J Clin Microbiol. 1996;34:1129-35.Google Scholar
25.Speert, DP, International Pseudomonas aeruginosa Typing Study Group. A multicenter comparison of methods for typing strains of Pseudomonas aeruginosa predominantly from patients with cystic fibrosis. J Infect Dis. 1994;169:134-42.Google Scholar
26.LiPuma, JJ. Burkholderia cepacia epidemiology and pathogenesis: implications for infection control. Curr Opin Pulm Med. 1998;4:337–41.CrossRefGoogle ScholarPubMed
27.LiPuma, JJ, Spilker, T, Gill, LH, Campbell, PW III, Liu, L, Mahenthiralingam, E. Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis. Am J Respir Crit Care Med. 2001;164:926.Google Scholar
28.Bernhardt, S, Spilker, T, LiPuma, JJ. Strain variation during chronic Burkholderia species infection in cystic fibrosis. Submitted.Google Scholar
29.Massion, PP, Hebert, CA, Leong, S, et al. Staphylococcus aureus stimulates neutrophil recruitment by stimulating interleukin-8 production in dog trachea. Am J Physiol. 1995;268:L85–94.Google Scholar
30.Mahenthiralingam, E, Vandamme, P, Campbell, ME, et al. Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans. Clin Infect Dis. 2001;33:1469-75.Google Scholar
31.Cheng, K, Smyth, RL, Govan, JR, et al. Spread of beta-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet. 1996;348:639-42.CrossRefGoogle Scholar
32.Farrell, PM, Shen, G, Splaingard, M, et al.. Acquisition of Pseudomonas aeruginosa in children with cystic fibrosis. Pediatrics. 1997;100:E2.CrossRefGoogle ScholarPubMed
33.Hunfeld, KP, Schmidt, C, Krackhardt, B, et al. Risk of Pseudomonas aeruginosa cross-colonization in patients with cystic fibrosis within a holiday camp—a molecular-epidemiological study. Wien Klin Wochenschr. 2000;112:329-33.Google Scholar
34.Jones, AM, Govan, JR, Doherty, CJ, et al. Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic. Lancet. 2001;358:557-8.CrossRefGoogle Scholar
35.McCallum, SJ, Corkill, J, Gallagher, M, Ledson, MJ, Hart, CA, Walshaw, MJ. Superinfection with a transmissible strain of Pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P. aeruginosa. Lancet. 2001;358:558-60.CrossRefGoogle ScholarPubMed
36.Ojeniyi, B, Frederiksen, B, Hoiby, N. Pseudomonas aeruginosa cross-infection among patients with cystic fibrosis during a winter camp. Pediatr Pulmonol. 2000;29:177-81.Google Scholar
37.Pedersen, SS, Koch, C, Hoiby, N, Rosendal, K. An epidemic spread of multiresistant Pseudomonas aeruginosa in a cystic fibrosis centre. J Antimicrob Chemother. 1986;17:505-16.CrossRefGoogle Scholar
38.Krzewinksi, JW, Nguyen, CD, Foster, JM, Burns, JL. Use of random amplified polymorphic DNA polymerase chain reaction to determine the epidemiology of Stenotrophomonas maltophilia and Achromobacter (Alcaligenes) xylosoxidans from patients with cystic fibrosis. J Clin Microbiol. 2001;39:3597-602.Google Scholar
39.Moissenet, D, Baculard, A, Valdn, M, et al. Colonization by Alcaligenes xylosoxidans in children with cystic fibrosis: a retrospective clinical study conducted by means of molecular epidemiological investigation. Clin Infect Dis. 1997;24:274-5.CrossRefGoogle ScholarPubMed
40.Valdezate, S, Vindel, A, Maiz, L, Baquero, F, Escobar, H, Canton, R. Persistence and variability of Stenotrophomonas maltophilia in cystic fibrosis patients, Madrid, 1991-1998. Emerg Infect Dis. 2001;7:113-21.Google Scholar
41.Gaynes, RP. Surveillance of nosocomial infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Philadelphia, PA: Lippincott-Raven; 1998:6584.Google Scholar
42.Perl, TM. Surveillance, reporting, and use of computers in prevention and control of noscomial infections. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 4th ed. Baltimore, MD: Williams and Wilkins; 1997:127-61.Google Scholar
43.Pottinger, JM, Herwaldt, LA, Perl, TM. Basics of surveillance—an overview. Infect Control Hosp Epidemiol. 1997;18:513-27.Google Scholar
44. Guidelines for Environmental Infection Control in Healthcare Facilities, 2001. Hospital Infection Control Practices Advisory Committee (HICPAC). In press.Google Scholar
45.Guidelines for prevention of nosocomial pneumonia. Resp Care. 1994;39:11911236.Google Scholar
46.Bolyard, EA, Tablan, OC, Williams, WW, Pearson, ML, Shapiro, CN, Deitchmann, SD. Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1998;19:407-63.Google Scholar
47.McNeil, SA, Foster, CL, Hedderwick, SA, Kauffman, CA. Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers. Clin Infect Dis. 2001;32:367-72.CrossRefGoogle ScholarPubMed
48.Passaro, DJ, Waring, L, Armstrong, R, et al. Postoperative Serratia marcescens wound infections traced to an out-of- hospital source. J Infect Dis. 1997;175:992-5.Google Scholar
49.Parry, MF, Grant, B, Yukna, M, et al. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis. 2001;32:352-7.CrossRefGoogle ScholarPubMed
50.Moolenaar, RL, Crutcher, JM, San Joaquin, VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol. 2000;21:80-5.Google Scholar
51.Foca, M, Jakob, K, Whittier, S, et al. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med. 2000;343:695700.Google Scholar
52.Walsh, NM, Casano, AA, Manangan, LP, Sinkowitz-Cochran, RL, Jarvis, WR. Risk factors for Burkholderia cepacia complex colonization and infection among patients with cystic fibrosis. J Pediatr. 2002;141:512-7.CrossRefGoogle ScholarPubMed
53.Hamill, RJ, Houston, ED, Georghiou, PR, et al. An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med. 1995;122:762-66.Google Scholar
54.Crespo, A, Axelrod, P, St. John, K, et al. An epidemic of Burkholderia cepacia pneumonia linked to specific practices in the handling of albuterol for nebulizers. Presented at the 12th annual meeting of the Society for Healthcare Epidemiology of America (SHEA); April 8, 2001; Salt Lake City, Utah.Google Scholar
55.Mertz, JJ, Scharer, L, McClement, JH. A hospital outbreak of Klebsiella pneumonia from inhalation therapy with contaminated aerosol solutions. Am Rev Respir Dis. 1967;95:454-60.Google ScholarPubMed
56.Ramsey, AH, Skonieczny, P, Coolidge, DT, Kurzynski, TA, Proctor, ME, Davis, JP. Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist. Infect Control Hosp Epidemiol. 2001;22:423-6.Google Scholar
57.Sanders, CV Jr, Luby, JP, Johanson, WG Jr, Barnett, JA, Sanford, JP. Serratia marcescens infections from inhalation therapy medications: nosocomial outbreak. Ann Intern Med. 1970;73:1521.Google Scholar
58.Hoffmann, KK, Weber, DJ, Rutala, WA. Pseudo epidemic of Rhodotorula rubra in patients undergoing fiberoptic bronchoscopy. Infect Control Hosp Epidemiol. 1989;10:511-4.Google Scholar
59.Favero, MS, Carson, LA, Bond, WW, Petersen, NJ. Pseudomonas aeruginosa: growth in distilled water from hospitals. Science. 1971;173:836-8.Google Scholar
60.Carson, LA, Favero, MS, Bond, WW, Petersen, NJ. Morphological, biochemical, and growth characteristics of pseudomonas cepacia from distilled water. Appl Microbiol. 1973 ;25:476-83.CrossRefGoogle ScholarPubMed
61.Hutchinson, GR, Parker, S, Pryor, JA, et al. Home-use nebulizers: a potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis. J Clin Microbiol. 1996;34:584-7.CrossRefGoogle ScholarPubMed
62.Pitchford, KC, Corey, M, Highsmith, AK, et al. Pseudomonas species contamination of cystic fibrosis patients' home inhalation equipment. J Pediatr. 1987;111:212-6.Google Scholar
63.Rosenfeld, M, Joy, P, Nguyen, CD, Krzewinkski, JW, Burns, JL. Cleaning home nebulizers used by patients with cystic fibrosis: is rinsing with tap water enough? J Hosp Infect. 2001;49:229-30.CrossRefGoogle Scholar
64.Jakobsson, BM, Onnered, AB, Hjelte, L, Nystrom, B. Low bacterial contamination of nebulizers in home treatment of cystic fibrosis patients. J Hosp Infect. 1997;36:201-7.CrossRefGoogle ScholarPubMed
65.Merritt, K, Hitchins, VM, Brown, SA. Safety and cleaning of medical materials and devices. J Biomed Mater Res. 2000;53:131-6.Google Scholar
66.Best, M, Sattar, SA, Springthorpe, VS, Kennedy, ME. Comparative mycobactericidal efficacy of chemical disinfectants in suspension and carrier tests. Appl Environ Microbiol. 1988;54:2856-8.Google Scholar
67.Luebbert, P. Home care. In: Ja, P, ed. Association for Professionals in Infection Control (APIC) Text of Infection Control and Epidemiology. Washington, DC: Association for Professionals in Infection Control and Epidemiology Inc; 2000:47.Google Scholar
68.Karapinar, M, Gonul, SA. Effects of sodium bicarbonate, vinegar, acetic and citric acids on growth and survival of Yersinia enterocolitica. Int J Food Microbiol. 1992;16:343-7.Google Scholar
69.Rutala, WA, Barbee, SL, Aguiar, NC, Sobsey, MD, Weber, DJ. Antimicrobial activity of home disinfectants and natural products against potential human pathogens. Infect Control Hosp Epidemiol. 2000;21:33-8.Google Scholar
70.Mangram, A, Jarvis, WR. Nosocomial Burkholderia cepacia outbreaks and pseudo-outbreaks. Infect Control Hosp Epidemiol. 1996;17:718-20.Google Scholar
71.Cefai, C, Richards, J, Gould, FK, McPeake, P. An outbreak of Acinetobacter respiratory tract infection resulting from incomplete disinfection of ventilatory equipment. J Hosp Infect. 1990;15:177-82.CrossRefGoogle ScholarPubMed
72.Gurevich, I, Tafuro, P, Ristuccia, P, Herrmann, J, Young, AR, Cunha, BA. Disinfection of respirator tubing: a comparison of chemical versus hot water machine-assisted processing. J Hosp Infect. 1983;4:199208.CrossRefGoogle ScholarPubMed
73.Rosaspina, S, Salvatorelli, G, Anzanel, D. The bactericidal effect of microwaves on Mycobacterium bovis dried on scalpel blades. J Hosp Infect. 1994;26:4550.Google Scholar
74.Rosaspina, S, Salvatorelli, G, Anzanel, D, Bovolenta, R. Effect of microwave radiation on Candida albicans. Microbios. 1994;78:55-9.Google ScholarPubMed
75.Sanborn, MR, Wan, SK, Bulard, R. Microwave sterilization of plastic tissue culture vessels for reuse. Appl Environ Microbiol. 1982;44:960-4.CrossRefGoogle ScholarPubMed
76.Tablan, OC, Chorba, TL, Schidlow, DV, et al. Pseudomonas cepacia colonization in patients with cystic fibrosis: risk factors and clinical outcome. J Pediatr. 1985;107:382-7.Google Scholar
77.Recommendations of the Clinical Subcommittee of the Medical/Scientific Advisory Committee of the Canadian CF Foundation. Microbiological processing of respiratory specimens from patients with cystic fibrosis. Can J Infect Dis. 1993;4:166169.Google Scholar
78.Medical/Scientific Advisory Committee of the Canadian CF Foundation. Epidemiology of Pseudomonas aeruginosa in cystic fibrosis. Can J Infect Dis. 1993;4:163-65.Google Scholar
79. Cystic Fibrosis Trust Infection Control Group: a statement on Burkholderia cepacia. UK Cystic Fibrosis Trust. 1999.Google Scholar
80.Doring, G, Schaffar, L eds. Epidemiology of Pulmonary Infections by Pseudomonas in Patients With Cystic Fibrosis: A Consensus Report. Paris, France: AFLM; 1993.Google Scholar
81.Valerius, NH, Koch, C, Hoiby, N. Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatment. Lancet. 1991;338:725-6.Google Scholar
82.Hoiby, N, Pedersen, SS. Estimated risk of cross-infection with Pseudomonas aeruginosa in Danish cystic fibrosis patients. Acta Paediatr Scand. 1989;78:395404.CrossRefGoogle ScholarPubMed
83.Frederiksen, B, Koch, C, Hoiby, N. Changing epidemiology of Pseudomonas aeruginosa infection in Danish cystic fibrosis patients (1974-1995). Pediatr Pulmonol. 1999;28:159-66.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
84.Pedersen, SS, Jensen, T, Hoiby, N, Koch, C, Flensborg, EW. Management of Pseudomonas aeruginosa lung infection in Danish cystic fibrosis patients. Acta Paediatr Scand. 1987;76:955-61.Google Scholar
85.Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol. 1995;16:686-96.Google Scholar
86.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol. 1996;143:496504.CrossRefGoogle ScholarPubMed
87.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA. 1999;282:1745-51.Google Scholar
88.Puzniak, LA, Leet, T, Mayfield, J, Kollef, M, Mundy, LM. To gown or not to gown: the effect on acquisition of vancomycin- resistant enterococci. Clin Infect Dis. 2002;35:1825.Google Scholar
89.Shay, DK, Maloney, SA, Montecalvo, M, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis. 1995;172:9931000.CrossRefGoogle ScholarPubMed
90.Montecalvo, MA, Jarvis, WR, Uman, J, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med. 1999;131:269-72.Google Scholar
91.Boyce, JM, Opal, SM, Chow, JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol. 1994;32:1148-53.CrossRefGoogle ScholarPubMed
92.Jochimsen, EM, Fish, L, Manning, K, et al. Control of vancomycin-resistant enterococci at a community hospital: efficacy of patient and staff cohorting. Infect Control Hosp Epidemiol. 1999;20:106-9.Google Scholar
93.Macartney, KK, Gorelick, MH, Manning, ML, Hodinka, RL, Bell, LM. Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control. Pediatrics. 2000;106:520-6.CrossRefGoogle ScholarPubMed
94.Leclair, JM, Freeman, J, Sullivan, BF, Crowley, CM, Goldmann, DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med. 1987;317:329-34.CrossRefGoogle ScholarPubMed
95.Ostrowsky, BE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med. 2001;344:1427-33.Google Scholar
96.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356:1307-12.Google Scholar
97.Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control. 1998;26:245-53.Google Scholar
98.Larson, EL, Early, E, Cloonan, P, Sugrue, S, Parides, M. An organizational climate intervention associated with increased hand washing and decreased nosocomial infections. Behav Med. 2000;26:14-22.Google Scholar
99.Pettinger, A, Nettleman, MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol. 1991;12:303-7.Google Scholar
100.Fitz-Simmons, SC. The changing epidemiology of cystic fibrosis. J Pediatr. 1993;122:19.Google Scholar
101.Gilligan, PH. Microbiology of airway disease in patients with cystic fibrosis. Clin Microbiol Rev. 1991;4:3551.CrossRefGoogle ScholarPubMed
102.Govan, JR, Brown, PH, Maddison, J, et al. Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis. Lancet. 1993;342:15-9.Google Scholar
103.Rosenfeld, M, Gibson, RL, McNamara, S, et al. Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis. Pediatr Pulmonol. 2001;32:356-66.CrossRefGoogle ScholarPubMed
104.Wong, K, Roberts, MC, Owens, L, Fife, M, Smith, AL. Selective media for the quantitation of bacteria in cystic fibrosis sputum. J Med Microbiol. 1984;17:113-9.Google Scholar
105.Chapin, KC, Murray, PR. Media. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington DC: ASM Press; 1999:16871707.Google Scholar
106.Kilbourn, JP, Campbell, RA, Grach, JL, Willis, MD. Quantitative bacteriology of sputum. Am Rev Resp Dis. 1968;98:810-8.Google Scholar
107.Gilligan, PH, Gage, PA, Bradshaw, LM, Schidlow, DV, DeCicco, BT. Isolation medium for the recovery of Pseudomonas cepacia from respiratory secretions of patients with cystic fibrosis. J Clin Microbiol. 1985;22:58.Google Scholar
108.Welch, DF, Muszynski, MJ, Pai, CH, et al. Selective and differential medium for recovery of Pseudomonas cepacia from the respiratory tracts of patients with cystic fibrosis. J Clin Microbiol. 1987;25:1730-4.Google Scholar
109.Tablan, OC, Carson, LA, Cusick, LB, Bland, LA, Martone, WJ, Jarvis, WR. Laboratory proficiency test results on use of selective media for isolating Pseudomonas cepacia from simulated sputum specimens of patients with cystic fibrosis. J Clin Microbiol. 1987;25:485-7.Google Scholar
110.Henry, DA, Campbell, ME, LiPuma, JJ, Speert, DP. Identification of Burkholderia cepacia isolates from patients with cystic fibrosis and use of a simple new selective medium. J Clin Microbiol. 1997;35:614-9.Google Scholar
111.Henry, D, Campbell, M, McGimpsey, C, et al. Comparison of isolation media for recovery of Burkholderia cepacia complex from respiratory secretions of patients with cystic fibrosis. J Clin Microbiol. 1999;37:1004-7.Google Scholar
112.Kloos, WE, Bannerman, TL. Staphylococcus and micrococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7 ed. Washington, DC: ASM Press; 1999:264287.Google Scholar
113.Swenson, JM, Hindler, JA, Peterson, LR. Special phenotypic methods for detecting antibacterial resistance. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:1563-77.Google Scholar
114.Gilligan, PH, Whittier, S. Burkholderia, Stenotrophomonas, Raltonia, Brevundimonas, Comamonas and Acidovorax. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7 ed. Washington, DC: ASM Press; 1999:526-38.Google Scholar
115.Denton, M, Hall, MJ, Todd, NJ, Kerr, KG, Littlewood, JM. Improved isolation of Stenotrophomonas maltophilia from the sputa of patients with cystic fibrosis using a selective medium. Clin Microbiol Infect. 2000;6:397-8.Google Scholar
116.Whittier, S, Hopfer, RL, Knowles, MR, Gilligan, PH. Improved recovery of mycobacteria from respiratory secretions of patients with cystic fibrosis. J Clin Microbiol. 1993;31:861-4.CrossRefGoogle ScholarPubMed
117.Whittier, S, Olivier, K, Gilligan, P, Knowles, M, Della-Latta, P. Proficiency testing of clinical microbiology laboratories using modified decontamination procedures for detection of nontuberculous mycobacteria in sputum samples from cystic fibrosis patients. The Nontuberculous Mycobacteria in Cystic Fibrosis Study Group. J Clin Microbiol. 1997;35:2706-8.Google Scholar
118.Bange, FC, Kirschner, P, Bottger, EC. Recovery of mycobacteria from patients with cystic fibrosis. J Clin Microbiol. 1999;37:3761-3.Google Scholar
119.Burns, JL, Saiman, L, Whittier, S, et al. Comparison of agar diffusion methodologies for antimicrobial susceptibility testing of Pseudomonas aeruginosa isolates from cystic fibrosis patients. J Clin Microbiol. 2000;38:1818-22.CrossRefGoogle ScholarPubMed
120.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33:2233-9.Google Scholar
121.Morel, AS, Saiman, L. The role of molecular epidemiologic typing in pediatric infection control. Semin Pediatr Infect Dis. 2001;12:100-6.Google Scholar
122.Ogle, JW, Janda, JM, Woods, DE, Vasil, ML. Characterization and use of a DNA probe as an epidemiological marker for Pseudomonas aeruginosa. J Infect Dis. 1987;155:119-26.Google Scholar
123.Mahenthiralingam, E, Campbell, ME, Speert, DP. Nonmotility and phagocytic resistance of Pseudomonas aeruginosa isolates from chronically colonized patients with cystic fibrosis. Infect Immun. 1994;62:596605.CrossRefGoogle ScholarPubMed
124.Hancock, RE, Mutharia, LM, Chan, L, Darveau, RP, Speert, DP, Pier, GB. Pseudomonas aeruginosa isolates from patients with cystic fibrosis: a class of serum-sensitive, nontypeable strains deficient in lipopolysac-charide O side chains. Infect Immun. 1983;42:170-7.Google Scholar
125.Thomassen, MJ, Demko, CA, Boxerbaum, B, Stern, RC, Kuchenbrod, PJ. Multiple isolates of Pseudomonas aeruginosa with differing antimicrobial susceptibility patterns from patients with cystic fibrosis. J Infect Dis. 1979;140:873-80.Google Scholar
126.Burns, JL, Gibson, RL, McNamara, S, et al. Longitudinal assessment of Pseudomonas aeruginosa in young children with cystic fibrosis. J Infect Dis. 2001;183:444-52.CrossRefGoogle ScholarPubMed
127.Ojeniyi, B, Lam, JS, Hoiby, N, Rosdahl, VT. A comparison of the efficiency in serotyping of Pseudomonas aeruginosa from cystic fibrosis patients using monoclonal and polyclonal antibodies. APMIS. 1989;97:631-6.CrossRefGoogle ScholarPubMed
128.Schlichting, C, Branger, C, Fournier, JM, et al. Typing of Staphylococcus aureus by pulsed-field gel electrophoresis, zymotyping, capsular typing, and phage typing: resolution of clonal relationships. J Clin Microbiol. 1993;31:227-32.CrossRefGoogle ScholarPubMed
129.Goerke, C, Kraning, K, Stern, M, Doring, G, Botzenhart, K, Wolz, C. Molecular epidemiology of community-acquired Staphylococcus aureus in families with and without cystic fibrosis patients. J Infect Dis. 2000;181:984-9.Google Scholar
130.LiPuma, JJ, Mortensen, JE, Dasen, SE, et al. Ribotype analysis of Pseudomonas cepacia from cystic fibrosis treatment centers. J Pediatr. 1988;113:859-62.Google Scholar
131.Mahenthiralingam, E, Simpson, DA, Speert, DP. Identification and characterization of a novel DNA marker associated with epidemic Burkholderia cepacia strains recovered from patients with cystic fibrosis. J Clin Microbiol. 1997;35:808-16.CrossRefGoogle ScholarPubMed
132.Mahenthiralingam, E, Bischof, J, Byrne, SK, et al. DNA-Based diagnostic approaches for identification of Burkholderia cepacia complex, Burkholderia vietnamiensis, Burkholderia multivorans, Burkholderia sta-bilis, and Burkholderia cepacia genomovars I and III. J Clin Microbiol. 2000;38:3165-73.CrossRefGoogle ScholarPubMed
133.Gaynes, RP, Emori, TG. Surveillance for nosocomial infections. In: Abrutyn, E, Goldmann, DA, Scheckler, WE, eds. Saunders Infection Control Reference Service. Philadelphia, PA: WB Saunders Co; 2001:40-4.Google Scholar
134.Wenzel, RP, Nettleman, MD. Principles of hospital epidemiology. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Lippincott Williams & Wilkins; 1999:81-8.Google Scholar
135.Doring, G, Conway, SP, Heijerman, HG, et al. Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus. Eur Respir J. 2000;16:749-67.Google Scholar
136.Shreve, MR, Butler, S, Kaplowitz, HJ, et al. Impact of microbiology practice on cumulative prevalence of respiratory tract bacteria in patients with cystic fibrosis. J Clin Microbiol. 1999;37:753-7.Google Scholar
137.Johnson, C, Butler, S, Konstan, M, Morgan, W, Wohl, ME. Factors influencing outcomes in cystic fibrosis: a center-based analysis. Chest. 2003;123:20-7.Google Scholar
138.LiPuma, JJ. Burkholderia cepacia. Management issues and new insights. Clin Chest Med. 1998, ;19:473-86, vi.Google Scholar
139.Miall, LS, McGinley, NT, Brownlee, KG, Conway, SP. Methicillin resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis. Arch Dis Child. 2001;84:160-2.Google Scholar
140.Givney, R, Vickery, A, Holliday, A, Pegler, M, Benn, R. Methicillin-resistant Staphylococcus aureus in a cystic fibrosis unit. J Hosp Infect. 1997;35:2736.Google Scholar
141.Saiman, L, Hiatt, P. Cystic fibrosis. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases. In press.Google Scholar
142.Ramsey, BW. Management of pulmonary disease in patients with cystic fibrosis. N Engl J Med. 1996;335:179-88.Google Scholar
143.Ramsey, BW, Pepe, MS, Quan, JM, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. N Engl J Med. 1999;340:2330.Google Scholar
144.Stutman, HR, Lieberman, JM, Nussbaum, E, Marks, MI. Antibiotic prophylaxis in infants and young children with cystic fibrosis: a randomized controlled trial. J Pediatr. 2002;140:299305.Google Scholar
145.McKenney, D, Pouliot, KL, Wang, Y, et al. Broadly protective vaccine for Staphylococcus aureus based on an in vivo-expressed antigen. Science. 1999;284:1523-7.Google Scholar
146.Cramton, SE, Ulrich, M, Gotz, F, Doring, G. Anaerobic conditions induce expression of polysaccharide intercellular adhesin in Staphylococcus aureus and Staphylococcus epidermidis. Infect Immun. 2001;69:4079-85.Google Scholar
147.Kahl, B, Herrmann, M, Everding, AS, et al. Persistent infection with small colony variant strains of Staphylococcus aureus in patients with cystic fibrosis. J Infect Dis. 1998;177:1023-9.Google Scholar
148.Ulrich, M, Herbert, S, Berger, J, et al. Localization of Staphylococcus aureus in infected airways of patients with cystic fibrosis and in a cell culture model of S. aureus adherence. Am J Respir Cell Mol Biol. 1998;19:8391.Google Scholar
149.Imundo, L, Barasch, J, Prince, A, Al-Awqati, Q. Cystic fibrosis epithelial cells have a receptor for pathogenic bacteria on their apical surface. Proc Natl Acad Sci USA. 1995;92:3019-23.Google Scholar
150.Ben-Ari, J, Gozal, D, Dorio, RJ, Bowman, CM, Reiff, A, Walker, SM. Superantigens and cystic fibrosis: resistance of presenting cells to dexamethasone. Clin Diagn Lab Immunol. 2000;7:553-6.Google Scholar
151.Anderson, DH. Therapy and prognosis of fibrocystic disease of the pancreas. Pediatrics. 1949;3:406-17.Google Scholar
152.Shinefield, H, Black, S, Fattom, A, et al. Use of a Staphylococcus aureus conjugate vaccine in patients receiving hemodialysis. N Engl J Med. 2002;346:491-6.Google Scholar
153.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344:11-6.Google Scholar
154.Perl, TM, Roy, MC. Postoperative wound infections: risk factors and role of Staphylococcus aureus nasal carriage. J Chemother. 1995;7(suppl 3):2935.Google Scholar
155.Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346:1871-7.CrossRefGoogle ScholarPubMed
156.Branger, C, Gardye, C, Lambert-Zechovsky, N. Persistence of Staphylococcus aureus strains among cystic fibrosis patients over extended periods of time. J Med Microbiol. 1996;45:294301.Google Scholar
157.Lowy, FD. Staphylococcus aureus infections. N Engl J Med. 1998;339:520-32.Google Scholar
158.Sattler, CA, Mason, EJ, Kaplan, S. Prospective comparison of risk factors and demographic and clinical characteristics of community-acquired, methicillin-resistant versus methicillin-susceptible Staphylococcus aureus infection in children. Pediatr Infect Dis J. 2002;21:910-16.Google Scholar
159.Hussain, FM, Boyle-Vavra, S, Bethel, CD, Daum, RS. Current trends in community-acquired methicillin-resistant Staphylococcus aureus at a tertiary care pediatric facility. Pediatr Infect Dis J. 2000;19:1163-6.Google Scholar
160.Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998;279:593-8.Google Scholar
161.Naimi, TS, LeDell, KH, Boxrud, DJ, et al. Epidemiology and clonality of community-acquired methicillin resistant Staphylococcus aureus in Minnesota, 1996-1998. Clin Infect Dis. 2001;33:990-96.Google Scholar
162.Baba, T, Takeuchi, F, Kuroda, M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet. 2002;359:1819-27.Google Scholar
163.Abi-Hanna, P, Frank, AL, Quinn, JP, et al. Clonal features of community-acquired methicillin-resistant Staphylococcus aureus in children. Clin Infect Dis. 2000;30:630-1.Google Scholar
164.Boyce, JM. Are the epidemiology and microbiology of methicillin-resistant Staphylococcus aureus changing? JAMA. 1998;279:623-4.Google Scholar
165.Akram, J, Glatt, AE. True community-acquired methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol. 1998;19:106-7.Google Scholar
166.Sumrall, B, Nolan, R. Retrospective study of community acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) occurring during an epidemic of MRSA at a Veterans Affairs hospital. Infect Control Hosp Epidemiol. 1996;15(suppl, part2):28.Google Scholar
167.Edmond, MB, Wenzel, RP, Pasculle, AW. Vancomycin-resistant Staphylococcus aureus: perspectives on measures needed for control. Ann Intern Med. 1996;124:329-34.Google Scholar
168.Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol. 1997;18:622-7.Google Scholar
169.Bell, M, Seiber, K, Weatherly, M, Jarvis, W. Infection control and the cystic fibrosis population: a survey of prevailing practices. Infect Control Hosp Epidemiol. Submitted.Google Scholar
170.Thomas, SR, Gyi, KM, Gaya, H, Hodson, ME. Methicillin-resistant Staphylococcus aureus: impact at a national cystic fibrosis centre. J Hosp Infect. 1998;40:203-9.Google Scholar
171.Boxerbaum, B, Jacobs, MR, Cechner, RL. Prevalence and significance of methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis. Pediatr Pulmonol. 1988;4:159-63.Google Scholar
172.Abman, SH, Ogle, JW, Harbeck, RJ, Butler-Simon, N, Hammond, KB, Accurso, FJ. Early bacteriologic, immunologic, and clinical courses of young infants with cystic fibrosis identified by neonatal screening. J Pediatr. 1991;119:211-7.Google Scholar
173.Hudson, VL, Wielinski, CL, Regelmann, WE. Prognostic implications of initial oropharyngeal bacterial flora in patients with cystic fibrosis diagnosed before the age of 2 years. J Pediatr. 1993;122:854-60.Google Scholar
174.Kosorok, MR, Zeng, L, West, SE, et al. Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition. Pediatr Pulmonol. 2001;32:277-87.Google Scholar
175.Henry, RL, Mellis, CM, Petrovic, L. Mucoid Pseudomonas aeruginosa is a marker of poor survival in cystic fibrosis. Pediatr Pulmonol. 1992;12:158-61.Google Scholar
176.Parad, RB, Gerard, CJ, Zurakowski, D, Nichols, DP, Pier, GB. Pulmonary outcome in cystic fibrosis is influenced primarily by mucoid Pseudomonas aeruginosa infection and immune status and only modestly by genotype. Infect Immun. 1999;67:4744-50.Google Scholar
177.West, SE, Zeng, L, Lee, BL, et al. Respiratory infection with Pseudomonas aeruginosa in children with cystic fibrosis: early detection by serology and assessment of risk factors. JAMA. 2002;287:2958-67.Google Scholar
178.Saiman, L, Mehar, F, Niu, WW, et al. Antibiotic susceptibility of multiply resistant Pseudomonas aeruginosa isolated from patients with cystic fibrosis, including candidates for transplantation. Clin Infect Dis. 1996;23:532-7.CrossRefGoogle ScholarPubMed
179.Ojeniyi, B, Petersen, US, Hoiby, N. Comparison of genome fingerprinting with conventional typing methods used on Pseudomonas aeruginosa isolates from cystic fibrosis patients. APMIS. 1993;101:168-75.Google Scholar
180.Romling, U, Fiedler, B, Bosshammer, J, et al. Epidemiology of chronic Pseudomonas aeruginosa infections in cystic fibrosis. J Infect Dis. 1994;170:1616-21.Google Scholar
181.Wolz, C, Kiosz, G, Ogle, JW, et al. Pseudomonas aeruginosa cross-colonization and persistence in patients with cystic fibrosis. Use of a DNA probe. Epidemiol Infect. 1989;102:205-14.Google Scholar
182.Zimakoff, J, Hoiby, N, Rosendal, K, Guilbert, JP. Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic. J Hosp Infect. 1983;4:3140.Google Scholar
183.Botzenhart, K, Doring, G. Epidemiology and ecology of Pseudomonas aeruginosa. In: Pseudomonas aeruginosa as an Opportunistic Pathogen. New York: Plenum; 1993:118.Google Scholar
184.Doring, G, Jansen, S, Noll, H, et al. Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward. Pediatr Pulmonol. 1996;21:90100.Google Scholar
185.Romling, U, Wingender, J, Muller, H, Tummler, B. A major Pseudomonas aeruginosa clone common to patients and aquatic habitats. Appl Environ Microbiol. 1994;60:1734-8.Google Scholar
186.Speert, DP, Campbell, ME. Hospital epidemiology of Pseudomonas aeruginosa from patients with cystic fibrosis. J Hosp Infect. 1987;9:1121.Google Scholar
187.Bosshammer, J, Fiedler, B, Gudowius, P, von der Hardt, H, Romling, U, Tummler, B. Comparative hygienic surveillance of contamination with pseudomonads in a cystic fibrosis ward over a 4-year period. J Hosp Infect. 1995;31:261-74.Google Scholar
188.Doring, G, Ulrich, M, Muller, W, et al. Generation of Pseudomonas aeruginosa aerosols during hand washing from contaminated sink drains, transmission to hands of hospital personnel, and its prevention by use of a new heating device. Zentralbl Hyg Umweltmed. 1991;191:494505.Google Scholar
189.Govan, JR, Nelson, JW. Microbiology of lung infection in cystic fibrosis. Br Med Bull. 1992;48:912-30.Google Scholar
190.Berrouane, YF, McNutt, LA, Buschelman, BJ, et al. Outbreak of severe Pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis. 2000;31:1331-7.Google Scholar
191.Fiorillo, L, Zucker, M, Sawyer, D, Lin, AN. The Pseudomonas hot-foot syndrome. N Engl J Med. 2001;345:335-8.Google Scholar
192.Jensen, ET, Giwercman, B, Ojeniyi, B, et al. Epidemiology otPseudomonas aeruginosa in cystic fibrosis and the possible role of contamination by dental equipment. J Hosp Infect. 1997;36:117-22.Google Scholar
193.Thomassen, MJ, Demko, CA, Doershuk, CF, Stern, RC, Klinger, JD. Pseudomonas cepacia: decrease in colonization in patients with cystic fibrosis. Am Rev Resp Dis. 1986;134:669-71.Google Scholar
194.Grothues, D, Koopmann, U, von der Hardt, H, Tummler, B. Genome fingerprinting of Pseudomonas aeruginosa indicates colonization of cystic fibrosis siblings with closely related strains. J Clin Microbiol. 1988;26:1973-7.Google Scholar
195.Fluge, O, Ojeniyi, B, Hoiby, N, et al. Typing of Pseudomonas aeruginosa strains in Norwegian cystic fibrosis patients. Clin Microbiol Infect. 2001;7:238-43.Google Scholar
196.Farrell, PM, Kosorok, MR, Laxova, A, et al. Nutritional benefits of neonatal screening for cystic fibrosis. Wisconsin Cystic Fibrosis Neonatal Screening Study Group. NEngl J Med. 1997;337:963-9.Google Scholar
197.Kosorok, MR, Jalaluddin, M, Farrell, PM, et al. Comprehensive analysis of risk factors for acquisition of Pseudomonas aeruginosa in young children with cystic fibrosis. Pediatr Pulmonol. 1998;26:81-8.Google Scholar
198.Speert, DP, Lawton, D, Damm, S. Communicability of Pseudomonas aeruginosa in a cystic fibrosis summer camp. J Pediatr. 1982;101:227-8.Google Scholar
199.Williams, T. Evaluation of antimicrobial sensitivity patterns as markers of Pseudomonas aeruginosa cross-infection at a cystic fibrosis clinic. Br J Biomed Sci. 1997;54:181-5.Google Scholar
200.Speert, DP, Campbell, ME, Henry, DA, et al. Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada. Am J Respir Crit Care Med. 2002;166:988-93.Google Scholar
201.McCallum, SJ, Gallagher, MJ, Corkill, JE, Hart, CA, Ledson, MJ, Walshaw, MJ. Spread of an epidemic Pseudomonas aeruginosa strain from a patient with cystic fibrosis (CF) to non-CF relatives. Thorax. 2002;57:559-60.Google Scholar
202.Coenye, T, Vandamme, P, Govan, JRW, LiPuma, JJ. Taxonomy and identification of the Burkholderia cepacia complex. J Clin Microbiol. 2001:34273436.Google Scholar
203.Speert, DP, Henry, D, Vandamme, P, Corey, M, Mahenthiralingam, E. Epidemiology of Burkholderia cepacia complex in patients with cystic fibrosis in Canada: geographical distribution and clustering of strains. Emerg Infect Dis. 2002;8:181-7.Google Scholar
204.Isles, A, Maclusky, I, Corey, M, et al. Pseudomonas cepacia infection in cystic fibrosis: an emerging problem. J Pediatr. 1984;104:206-10.Google Scholar
205.Tablan, OC, Martone, WJ, Doershuk, CF, et al. Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis. Risk factors and outcomes. Chest. 1987;91:527-32.Google Scholar
206.Kazachkov, M, Lager, J, LiPuma, J, Barker, PM. Survival following Burkholderia cepacia sepsis in a patient with cystic fibrosis treated with corticosteroids. Pediatr Pulmonol. 2001;32:338-40.Google Scholar
207.Drabick, JA, Gracely, EJ, Heidecker, GJ, LiPuma, JJ. Survival of Burkholderia cepacia on environmental surfaces. J Hosp Infect. 1996;32:267-76.Google Scholar
208.Corey, M, Farewell, V. Determinants of mortality from cystic fibrosis in Canada, 1970-1989. Am J Epidemiol. 1996;143:1007-17.Google Scholar
209.Liou, TG, Adler, FR, Fitz-Simmons, SC, Cahill, BC, Hibbs, JR, Marshall, BC. Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol. 2001;153:345-52.Google Scholar
210.Navarro, J, Rainisio, M, Harms, HK, et al. Factors associated with poor pulmonary function: cross-sectional analysis of data from the ERCF. European Epidemiologic Registry of Cystic Fibrosis. Eur Respir J. 2001;18:298305.Google Scholar
211.Rosenfeld, M, Davis, R, Fitz-Simmons, S, Pepe, M, Ramsey, B. Gender gap in cystic fibrosis mortality. Am J Epidemiol. 1997;145:794803.Google Scholar
212.Whiteford, ML, Wilkinson, JD, McColl, JH, et al. Outcome of Burkholderia (Pseudomonas) cepacia colonisation in children with cystic fibrosis followinga hospital outbreak. Thorax. 1995;50:1194-8.Google Scholar
213.Aris, RM, Routh, J, LiPuma, JJ, Heath, D, Gilligan, PH. Burkholderia cepacia complex in cystic fibrosis patients after lung transplantation: survival linked to genomovar type. Am J Resp Crit Care Med. 2001;164:21022106.Google Scholar
214.De Soyza, A, McDowell, A, Archer, L, et al. Burkholderia cepacia complex genomovars and pulmonary transplantation outcomes in patients with cystic fibrosis. Lancet. 2001;358:1780-1.Google Scholar
215.Ledson, MJ, Gallagher, MJ, Corkill, JE, Hart, CA, Walshaw, MJ. Cross infection between cystic fibrosis patients colonised with Burkholderia cepacia. Thorax. 1998;53:432-6.Google Scholar
216.Pegues, DA, Carson, LA, Tablan, OC, et al. Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. Summer Camp Study Group. J Pediatr. 1994;124:694702.Google Scholar
217.Pegues, DA, Schidlow, DV, Tablan, OC, Carson, LA, Clark, NC, Jarvis, WR. Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis. Arch Pediatr Adolesc Med. 1994;148:805-12.Google Scholar
218.LiPuma, JJ, Dasen, SE, Nielson, DW, Stern, RC, Stull, TL. Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis. Lancet. 1990;336:1094-6.Google Scholar
219.Centers for Disease Control. Pseudomonas cepacia at summer camps for persons with cystic fibrosis. MMWR Morb Mortal Wkly Rep. 1993;42:456-9.Google Scholar
220.Holmes, A, Nolan, R, Taylor, R, et al. An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis. 1999;179:1197-205.Google Scholar
221.Reboli, AC, Koshinski, R, Arias, K, Marks-Austin, K, Stieritz, D, Stull, TL. An outbreak of Burkholderia cepacia lower respiratory tract infection associated with contaminated albuterol nebulization solution. Infect Control Hosp Epidemiol. 1996;17:741-3.Google Scholar
222.Nelson, JW, Doherty, CJ, Brown, PH, Greening, AP, Kaufmann, ME, Govan, JR. Pseudomonas cepacia in inpatients with cystic fibrosis. Lancet. 1991;338:1525.Google Scholar
223.Pankhurst, CL, Harrison, VE, Philpott-Howard, J. Evaluation of contamination of the dentist and dental surgery environment with Burkholderia (Pseudomonas) cepacia during treatment of children with cystic fibrosis. Int J Paediatr Dent. 1995;5:243-7.Google Scholar
224.Ensor, E, Humphreys, H, Peckham, D, Webster, C, Knox, AJ. Is Burkholderia (Pseudomonas) cepacia disseminated from cystic fibrosis patients during physiotherapy? J Hosp Infect. 1996;32:915.Google Scholar
225.Humphreys, H, Peckham, D, Patel, P, Knox, A. Airborne dissemination of Burkholderia (Pseudomonas) cepacia from adult patients with cystic fibrosis. Thorax. 1994;49:1157-9.Google Scholar
226.Humphreys, H, Peckhman, D. Environmental sampling to detect Burkholderia cepacia in a cystic fibrosis outpatient clinic. Eur J Clin Microbiol Infect Dis. 1996;15:523-5.Google Scholar
227.Burdge, DR, Nakielna, EM, Noble, MA. Case-control and vector studies of nosocomial acquisition of Pseudomonas cepacia in adult patients with cystic fibrosis. Infect Control Hosp Epidemiol. 1993;14:127-30.Google Scholar
228.Sun, L, Jiang, RZ, Steinbach, S, et al. The emergence of a highly transmissible lineage of cbl+ Pseudomonas (Burkholderia) cepacia causing CF centre epidemics in North America and Britain. Nat Med. 1995;1:661-6.Google Scholar
229.Siddiqui, AH, Mulligan, ME, Mahenthiralingam, E, et al. An episodic outbreak of genetically related Burkholderia cepacia among non-cystic fibrosis patients at a university hospital. Infect Control Hosp Epidemiol. 2001;22:419-22.Google Scholar
230.Dy, ME, Nord, JA, LaBombardi, VJ, Germana, J, Walker, P. Lack of throat colonization with Burkholderia cepacia among cystic fibrosis healthcare workers. Infect Control Hosp Epidemiol. 1999;20:90.Google Scholar
231.Mortensen, JE, Fisher, MC, LiPuma, JJ. Recovery of Pseudomonas cepacia and other Pseudomonas species from the environment. Infect Control Hosp Epidemiol. 1995;16:30-2.Google Scholar
232.Butler, SL, Doherty, CJ, Hughes, JE, Nelson, JW, Govan, JR. Burkholderia cepacia and cystic fibrosis: do natural environments present a potential hazard? J Clin Microbiol. 1995;33:1001-4.Google Scholar
233.Balandreau, J, Viallard, V, Cournoyer, B, et al. Burkholderia cepacia genomovar III is a common plant-associated bacterium. Appl Environ Microbiol. 2001;67:982-85.Google Scholar
234.Gonzalez, CF, Mark, GL, Mahenthiralingam, E, LiPuma, JJ. Isolation of soilborne genomovar III Burkholderia cepacia and lytic phages with inter-genomovar host range. Pediatr Pulmonol. 2000;S20:288-9.Google Scholar
235.Bevivino, A, Dalmastri, C, Tabacchioni, S, et al. Burkholderia cepacia complex bacteria from clinical and environmental sources in Italy: genomovar status and distribution of traits related to virulence and transmissibility. J Clin Microbiol. 2002;40:846-51.Google Scholar
236.LiPuma, JJ, Spilker, T, Coenye, T, Gonzalez, CF. An epidemic Burkholderia cepacia complex strain identified in soil. Lancet. 2002;359:2002-3.Google Scholar
237.Miller, SM, Parke, JL, Bies, S, LiPuma, JJ. Detection, recovery and identification of Burkholderia cepacia from the natural environment. Pediatr Pulmonol. 2000;S20:288.Google Scholar
238.Fung, SK, Dick, H, Devlin, H, Tullis, E. Transmissibility and infection control implications of Burkholderia cepacia in cystic fibrosis. Can Infect Dis J. 1998;9:177-82.Google Scholar
239.Paul, ML, Pegler, MA, Benn, RA. Molecular epidemiology of Burkholderia cepacia in two Australian cystic fibrosis centres. J Hosp Infect. 1998;38:1926.Google Scholar
240.Denton, M, Kerr, KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. 1998;11:5780.Google Scholar
241.Sattler, C, Mason, EJ, Kaplan, S. Nonrespiratory Stenotrophomonas maltophilia infection at a children's hospital. Clin Infect Dis. 2000;31:1321-30.Google Scholar
242.Sattler, CA. Stenotrophomonas maltophilia infection in children. Pediatr Infect Dis J. 2000;19:877-8.Google Scholar
243.Elting, LS, Khardori, N, Bodey, GP, Fainstein, V. Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors. Infect Control Hosp Epidemiol. 1990;11:134-8.Google Scholar
244.Demko, CA, Stern, RC, Doershuk, CF. Stenotrophomonas maltophilia in cystic fibrosis: incidence and prevalence. Pediatr Pulmonol. 1998;25:304-8.Google Scholar
245.Denton, M, Todd, NJ, Kerr, KG, Hawkey, PM, Littlewood, JM. Molecular epidemiology of Stenotrophomonas maltophilia isolated from clinical specimens from patients with cystic fibrosis and associated environmental samples. J Clin Microbiol. 1998;36:1953-8.Google Scholar
246.Talmaciu, I, Varlotta, L, Mortensen, J, Schidlow, DV. Risk factors for emergence of Stenotrophomonas maltophilia in cystic fibrosis. Pediatr Pulmonol. 2000;30:10-5.Google Scholar
247.Burdge, DR, Noble, MA, Campbell, ME, Krell, VL, Speert, DP. Xanthomonas maltophilia misidentified as Pseudomonas cepacia in cultures of sputum from patients with cystic fibrosis: a diagnostic pitfall with major clinical implications. Clin Infect Dis. 1995;20:445-8.Google Scholar
248.Whitby, PW, Carter, KB, Burns, JL, Royall, JA, LiPuma, JJ, Stull, TL. Identification and detection of Stenotrophomonas maltophilia by rRNA-directed PCR. J Clin Microbiol. 2000;38:4305-9.Google Scholar
249.Saiman, L, Edwards, L. What is the association between CF pathogens and morbidity and mortality? Pediatr Pulmonol. 2000;S20:147-8.Google Scholar
250.Gladman, G, Connor, PJ, Williams, RF, David, TJ. Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis. Arch Dis Child. 1992;67:192-5.Google Scholar
251.Karpati, F, Malmborg, AS, Alfredsson, H, Hjelte, L, Strandvik, B. Bacterial colonization with Xanthomonas maltophilia—a retrospective study in a cystic fibrosis patient population. Infection. 1994;22:258-63.Google Scholar
252.Goss, CH, Aitken, ML, Otto, K, Rubenfeld, GD. Acquiring Stenotrophomonas maltophilia does not reduce survival in patients with cystic fibrosis. Pediatr Pulmonol. 2000;S20:101-2.Google Scholar
253.Saiman, L, Chen, Y, Tabibi, S, et al. Identification and antimicrobial susceptibility of Alcaligenes xylosoxidans isolated from patients with cystic fibrosis. J Clin Microbiol. 2001;39:3942-5.Google Scholar
254.Liu, L, Coenye, T, Burns, JL, Whitby, PW, Stull, TL, LiPuma, JJ. Ribosomal DNA-directed PCR for identification of Achromobacter (Alcaligenes) xylosoxidans recovered from sputum samples from cystic fibrosis patients. J din Microbiol. 2002;40:1210-3.Google Scholar
255.Fabbri, A, Tacchella, A, Manno, G, Viscoli, C, Palmero, C, Gargani, GF. Emerging microorganisms in cystic fibrosis. Chemioterapia. 1987;6:32-7.Google Scholar
256.Dunne, WM Jr, Maisch, S. Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction. Clin Infect Dis. 1995;20:836-41.Google Scholar
257.Vu-Thien, H, Moissenet, D, Valcin, M, Dulot, C, Tournier, G, Garbarg-Chenon, A. Molecular epidemiology of Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans in a cystic fibrosis center. Eur J Clin Microbiol Infect Dis. 1996;15:876-9.Google Scholar
258.Horsburgh, CR Jr. Epidemiology of disease caused by nontuberculous mycobacteria. Semin Respir Infect. 1996;11:244-51.Google ScholarPubMed
259.Falkinham, JO III. Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev. 1996;9:177215.Google Scholar
260.Benator, DA, Gordin, FM. Nontuberculous mycobacteria in patients with human immunodeficiency virus infection. Semin Respir Infect. 1996;11:285300.Google Scholar
261.Newport, MJ, Huxley, CM, Huston, S, et al. A mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infection. N Engl J Med. 1996;335:1941-9.Google Scholar
262.American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med. 1997;156:S1-25.Google Scholar
263.Wallace, RJ Jr, Brown, BA, Griffith, DE. Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. Annu Rev Microbiol. 1998;52:453-90.Google Scholar
264.Winthrop, KL, Abrams, M, Yakrus, M, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002;346:1366-71.Google Scholar
265.Smith, MJ, Efthimiou, J, Hodson, ME, Batten, JC. Mycobacterial isolations in young adults with cystic fibrosis. Thorax. 1984;39:369-75.Google Scholar
266.Kilby, JM, Gilligan, PH, Yankaskas, JR, Highsmith, WE Jr, Edwards, LJ, Knowles, MR. Nontuberculous mycobacteria in adult patients with cystic fibrosis. Chest. 1992;102:70-5.Google Scholar
267.Aitken, ML, Burke, W, McDonald, G, Wallis, C, Ramsey, B, Nolan, C. Nontuberculous mycobacterial disease in adult cystic fibrosis patients. Chest. 1993;103:1096-9.Google Scholar
268.Hjelt, K, Hojlyng, N, Howitz, P, et al. The role of mycobacteria other than tuberculosis (MOTT) in patients with cystic fibrosis. Scand Infect Dis. 1994;26:569-76.Google Scholar
269.Olivier, KN, Yankaskas, JR, Knowles, MR. Nontuberculous mycobacterial pulmonary disease in cystic fibrosis. Semin Respir Infect. 1996;11:272-84.Google Scholar
270.Olivier, K, Handler, A, Less, JH, Tudor, G, Knowles, MR. Clinical impact of nontuberculous mycobacteria on the course of cystic fibrosis lung disease: results of a multicenter nested cohort study. Pediatr Pulmonol. 2000:102-3.Google Scholar
271.Torrens, JK, Dawkins, P, Conway, SP, Moya, E. Non-tuberculous mycobacteria in cystic fibrosis. Thorax. 1998;53:182-5.Google Scholar
272.Fauroux, B, Delaisi, B, Clement, A, et al. Mycobacterial lung disease in cystic fibrosis: a prospective study. Pediatr Infect Dis J. 1997;16:354-8.Google Scholar
273.Oermann, CM, Starke, JR, Seilheimer, DK. Pulmonary disease caused by Mycobacterium kansasii in a patient with cystic fibrosis. Pediatr Infect Dis J. 1997;16:257-9.Google Scholar
274.Oliver, A, Maiz, L, Canton, R, Escobar, H, Baquero, F, Gomez-Mampaso, E. Nontuberculous mycobacteria in patients with cystic fibrosis. Clin Infect Dis. 2001;32:1298-303.Google Scholar
275.Tomashefski, JF Jr, Stern, RC, Demko, CA, Doershuk, CF. Nontuberculous mycobacteria in cystic fibrosis. An autopsy study. Am J Respir Crit Care Med. 1996;154:523-8.Google Scholar
276.Cullen, AR, Cannon, CL, Mark, EJ, Colin, AA. Mycobacterium abscessus infection in cystic fibrosis. Colonization or infection? Am J Respir Crit Care Med. 2000;161:641-5.Google Scholar
277.Olivier, KN, Weber, DJ, Wallace, RJ Jr, et al. Nontuberculous mycobacteria, I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med. 2003;167:828-34.Google Scholar
278.Bange, FC, Brown, BA, Smaczny, C, Wallace, RJ Jr, Bottger, EC. Lack of transmission of Mycobacterium abscessus among patients with cystic fibrosis attending a single clinic. Clin Infect Dis. 2001;32:1648-50.Google Scholar
279.Brown, K, Rosenthal, M, Bush, A. Fatal invasive aspergillosis in an adolescent with cystic fibrosis. Pediatr Pulmonol. 1999;27:130-3.Google Scholar
280.Maguire, CP, Hayes, JP, Hayes, M, Masterson, J, FitzGerald, MX. Three cases of pulmonary aspergilloma in adult patients with cystic fibrosis. Thorax. 1995;50:805-6.Google Scholar
281.Burns, JL, Van Dalfsen, JM, Shawar, RM, et al. Effect of chronic intermittent administration of inhaled tobramycin on respiratory microbial flora in patients with cystic fibrosis. J Infect Dis. 1999;179:1190-96.Google Scholar
282.Bargon, J, Dauletbaev, N, Kohler, B, Wolf, M, Posselt, HG, Wagner, TO. Prophylactic antibiotic therapy is associated with an increased prevalence of Aspergillus colonization in adult cystic fibrosis patients. Respir Med. 1999;93:835-8.Google Scholar
283.Cimon, B, Carrere, J, Vinatier, JF, Chazalette, JP, Chabasse, D, Bouchara, JP. Clinical significance of Scedosporium apiospermum in patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis. 2000;19:53-6.Google Scholar
284.Geller, DE, Kaplowitz, H, Light, MJ, Colin, AA. Allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Scientific Advisory Group, Investigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Chest. 1999;116:639-46.Google Scholar
285.Mastella, G, Rainisio, M, Harms, HK, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis. A European epidemiological study. Epidemiologic Registry of Cystic Fibrosis. Eur Respir J. 2000;16:464-71.Google Scholar
286.Bartley, J. Construction. In: Olmstead, RN, ed. Association for Professionals in Infection Control (APIC), Infection Control and Applied Epidemiology: Principles and Practice. St. Louis, MO: Mosby Year Book Publications; 1996:104:16.Google Scholar
287.Pegues, DA, Lasker, BA, McNeil, MM, Hamm, PM, Lundal, JI, Kubak, BM. Cluster of cases of invasive aspergillosis in a transplant intensive care unit: Evidence of person-to-person transmission. Clin Infect Dis. 2002;34:412-16.Google Scholar
288.Ramsey, BW, Gore, EJ, Smith, AL, Cooney, MK, Redding, GJ, Foy, H. The effect of respiratory viral infections on patients with cystic fibrosis. Am J Dis Child. 1989;143:662-8.Google Scholar
289.Hiatt, PW, Grace, SC, Kozinetz, CAet al. Effects of viral lower respiratory tract infection on lung function in infants with cystic fibrosis. Pediatr. 1999;103:619-26.Google Scholar
290.Pribble, CG, Black, PG, Bosso, JA, Turner, RB. Clinical manifestations of exacerbations of cystic fibrosis associated with nonbacterial infections. J Pediatr. 1990;117:200-4.Google Scholar
291.Wang, EE, Prober, CG, Manson, B, Corey, M, Levison, H. Association of respiratory viral infections with pulmonary deterioration in patients with cystic fibrosis. N Engl J Med. 1984;311:1653-8.Google Scholar
292.Smyth, AR, Smyth, RL, Tong, CY, Hart, CA, Heaf, DR. Effect of respiratory virus infections including rhinovirus on clinical status in cystic fibrosis. Arch Dis Child. 1995;73:117-20.Google Scholar
293.Armstrong, D, Grimwood, K, Carlin, JB, et al. Severe viral respiratory infections in infants with cystic fibrosis. Pediatr Pulmonol. 1998;26:371-9.Google Scholar
294.Hall, CB. Respiratory syncytial virus: a continuing culprit and conundrum. J Pediatr. 1999;135:27.Google Scholar
295.Hall, CB, Powell, KR, MacDonald, NE, et al. Respiratory syncytial viral infection in children with compromised immune function. N Engl J Med. 1986;315:7781.Google Scholar
296.From the Centers for Disease Control and Prevention. Update: respiratory syncytial virus activity—United States, 1997-98 season. JAMA. 1998;279:264-5.Google Scholar
297.Abman, SH, Ogle, JW, Butler-Simon, N. Rumack, CM, Accurso, FJ. Role of respiratory syncytial virus in early hospitalizations for respiratory distress of young infants with cystic fibrosis. J Pediatr. 1988;113:826-30.Google Scholar
298.Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn. Pediatrics. 1998;102:1211-6.Google Scholar
299.Arnold, SR, Wang, EE, Law, BJ, et al. Variable morbidity of respiratory syncytial virus infection in patients with underlying lung disease: a review of the PICNIC RSV database. Pediatric Investigators Collaborative Network on Infections in Canada. Pediatr Infect Dis J. 1999;18:866-9.Google Scholar
300.Piedra, PA, Grace, S, Jewell, A, et al. Purified fusion protein vaccine protects against lower respiratory tract illness during respiratory syncytial virus season in children with cystic fibrosis. Pediatr Infect Dis J. 1996;15:2331.Google Scholar
301.Bridges, CB, Fukuda, K, Uyeki, TM, Cox, NJ, Singleton, JA. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices AC1P). MMWR Recomm Rep. 2002;51(RR-3):131.Google Scholar
302.Ferson, MJ, Morton, JR, Robertson, PW. Impact of influenza on morbidity in children with cystic fibrosis. J Paediatr Child Health. 1991;27:308-11.Google Scholar
303.Conway, SP, Simmonds, EJ, Littlewood, JM. Acute severe deterioration in cystic fibrosis associated with influenza A virus infection. Thorax. 1992;47:112-4.Google Scholar
304.Gruber, WC, Campbell, PW, Thompson, JM, Reed, GW, Roberts, B, Wright, PE. Comparison of live attenuated and inactivated influenza vaccines in cystic fibrosis patients and their families: results of a 3-year study. J Infect Dis. 1994;169:241-7.Google Scholar
305.Gross, PA, Denning, CR, Gaerlan, PF, et al. Annual influenza vaccination: immune response in patients over 10 years. Vaccine. 1996;14:1280-4.Google Scholar
306.Gern, JE, Busse, WW. Association of rhinovirus infections with asthma. Clin Microbiol Rev. 1999;12:9-18.Google Scholar
307.Yankaskas, JR, Mallory, GB Jr. Lung transplantation in cystic fibrosis: consensus conference statement. Chest. 1998;113:217-26.Google Scholar
308.Aris, RM, Gilligan, PH, Neuringer, IP, Gott, KK, Rea, J, Yankaskas, JR. The effects of panresistant bacteria in cystic fibrosis patients on lung transplant outcome. Am J Respir Crit Care Med. 1997;155:1699-704.Google Scholar
309.LiPuma, JJ. Burkholderia cepacia: a contraindication to lung transplantation in CF? Transpl Infect Dis. 2001;3:150-62.Google Scholar
310.Snell, GI, de Hoyos, A, Krajden, M, Winton, T, Maurer, JR. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest. 1993;103:466-71.Google Scholar
311.Steinbach, S, Sun, L, Jiang, RZ, et al. Transmissibility of Pseudomonas cepacia infection in clinic patients and lung-transplant recipients with cystic fibrosis. N Engl J Med. 1994;331:981-7.Google Scholar
312.Chaparro, C, Maurer, J, Gutierrez, C, et al. Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation. Am J Respir Crit Care Med. 2001;163:43-8.Google Scholar
313.Walter, S, Gudowius, P, Bosshammer, J, et al. Epidemiology of chronic Pseudomonas aeruginosa infections in the airways of lung transplant recipients with cystic fibrosis. Thorax. 1997;52:318-21.Google Scholar
314.Kanj, SS, Tapson, V, Davis, RD, Madden, J, Browning, I. Infections in patients with cystic fibrosis following lung transplantation. Chest. 1997;112:924-30.Google Scholar
315.Nunley, DR, Grgurich, W, Iacono, AT, et al. Allograft colonization and infections with Pseudomonas in cystic fibrosis lung transplant recipients. Chest. 1998;113:1235-43.Google Scholar
316.Nunley, DR, Ohori, P, Grgurich, WF, et al. Pulmonary aspergillosis in cystic fibrosis lung transplant recipients. Chest. 1998;114:1321-9.Google Scholar
317.Paradowski, LJ. Saprophytic fungal infections and lung transplantation—revisited. J Heart Lung Transplant. 1997;16:524-31.Google Scholar
318.Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR Morb Mortal Wkly Rep. 2000;49(RR-10):1125.Google Scholar
319.Walters, S, Smith, EG. Pseudomonas cepacia in cystic fibrosis: transmissibility and its implications. Lancet. 1993;342:34.Google Scholar
320.Bennett, SM. ‘Patient perspective’ - psychological effects of barrier nursing isolation. Australian Nurses J. 1983;12:36-7, 44.Google Scholar
321.Gammon, J. Analysis of the stressful effects of hospitalization and source isolation on coping and psychological constructs. Nursing Pract. 1998;4:8496.Google Scholar
322.Gammon, J. The psychological consequences of source isolation: a review of the literature. J Clin Nursing. 1999;8:1321.Google Scholar
323.Kennedy, P, Hamilton, LR. Psychological impact of the management of methicillin-resistant Staphylococcus aureus (MRSA) in patients with spinal cord injury. Spinal Cord. 1997;35:617-9.Google Scholar
324.Knowles, HE. The experience of infectious patients in isolation. Nursing Times. 1993;89:53-6.Google Scholar
325.Oldman, T. Isolated cases. Nursing Times. 1998;94:6770.Google Scholar
326.Wilkins, EG, Ellis, ME, Dunbar, EM, Gibbs, A. Does isolation of patients with infections induce mental illness? J Infect. 1988;17:43-7.Google Scholar
327.Powazek, M, Goff, JR, Schyving, J, Paulson, MA. Emotional reactions of children to isolation in a cancer hospital. J Pediatr. 1978;92:834-7.Google Scholar
328.Casey, V. The child in isolation: treatment or abuse? Nursing Praxis in N Zeal. 1989;5:1922.Google Scholar
329.Ward, D. Infection control: reducing the psychological effects of isolation. British J Nursing. 2000;9:162-70.Google Scholar
330.Campbell, T. Feelings of oncology patients about being nursed in protective isolation as a consequence of cancer chemotherapy treatment. J Adv Nurs. 1999;30:439-47.Google Scholar
331.Walter, S. Association of Cystic Fibrosis Adults Survey 1994. London: Cystic Fibrosis Trust; 1995.Google Scholar
332.Smith, DL, Gumery, LB, Smith, EG, Stableforth, DE, Kaufmann, ME, Pitt, TL. Epidemic of Pseudomonas cepacia in an adult cystic fibrosis unit evidence of person-to-person transmission. J Clin Microbiol. 1993;31:3017-22.Google Scholar
333.Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med. 1991;91:479-83.Google Scholar
334.Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and hand washing. Ann Intern Med. 1988;109:394-8.Google Scholar
335.Occupational exposure to bloodborne pathogens—OSHA Final rule. Federal Register. 1991;56:64004-182.Google Scholar
336.Rutala, WA. Disinfection and sterilization of patient-care items. Infect Control Hosp Epidemiol. 1996;17:377-84.Google Scholar
337.Chan-Myers, H, McAlister, D, Antonoplos, p. Natural bioburden levels detected on rigid lumened medical devices before and after cleaning. Am J Infect Control. 1997;25:471-6.Google Scholar
338.Jacobs, FT, Wang, J-H, Gorham, RA, Roberts, CG. Cleaning: principles, methods and benefits. In: Rutala, WA ed. Disinfection, Sterilization and Antisepsis in Health Care. Washington, DC: Association for Professionals in Infection Control and Epidemiology Inc; 1998.Google Scholar
339.Rutala, WA, Gergen, MF, Jones, JF, Weber, DJ. Levels of microbial contamination on surgical instruments. Am J Infect Control. 1998;26:143-5.Google Scholar
340.Alfa, MJ, DeGagne, P, Olson, N, Puchalski, T. Comparison of ion plasma, vaporized hydrogen peroxide, and 100% ethylene oxide sterilizers to the 12/88 ethylene oxide gas sterilizer. Infect Control Hosp Epidemiol. 1996;17:92100.Google Scholar
341.Bryce, EA, Chia, E, Logelin, G, Smith, JA. An evaluation of the AbTox Plazlyte Sterilization System. Infect Control Hosp Epidemiol. 1997;18:646-53.Google Scholar
342.Levy, RV. Sterile filtration of liquids and gases. In: Block, SS, ed. Disinfection, Sterilization and Preservation. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:795822.Google Scholar
343.Singh, J, Bhatia, R, Gandhi, JC, et al. Outbreak of viral hepatitis B in a rural community in India linked to inadequately sterilized needles and syringes. Bull World Health Organ. 1998;76:93-8.Google Scholar
344.Agerton, T, Valway, S, Gore, B, et al. Transmission of a highly drug-resistant strain (strain Wl) of Mycobacterium tuberculosis. Community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA. 1997;278:1073-7.Google Scholar
345.Bronowicki, JP, Venard, V, Botte, C, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med. 1997;337:237-40.Google Scholar
346.Michele, TM, Cronin, WA, Graham, NM, et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope. Identification by DNA fingerprinting. JAMA. 1997;278:1093-5.Google Scholar
347.Sattar, SA, Lloyd-Evans, N, Springthorpe, VS, Nair, RC. Institutional outbreaks of rotavirus diarrhoea: potential role of fomites and environmental surfaces as vehicles for virus transmission. J Hyg (Land). 1986;96:277-89.Google Scholar
348.Ward, RL, Bernstein, DI, Knowlton, DR, et al. Prevention of surface-to-human transmission of rotaviruses by treatment with disinfectant spray. J Clin Microbiol. 1991;29:1991-6.Google Scholar
349.Sattar, SA, Jacobsen, H, Springthorpe, VS, Cusack, TM, Rubino, JR. Chemical disinfection to interrupt transfer of rhinovirus type 14 from environmental surfaces to hands. Appl Environ Microbiol. 1993;59:1579-85.Google Scholar
350.Gwaltney, JM Jr, Hendley, JO. Transmission of experimental rhinovirus infection by contaminated surfaces. Am J Epidemiol. 1982;116:828-33.Google Scholar
351.Seto, WH, Ching, TY, Yuen, KY, Lam, WK. Evaluating the sterility of disposable wall oxygen humidifiers, during and between use on patients. Infect Control Hosp Epidemiol. 1990;11:604-5.Google Scholar
352.Golar, SD, Sutherland, LL, Ford, GT. Multipatient use of prefilled disposable oxygen humidifiers for up to 30 days: patient safety and cost analysis. Respir Care. 1993;38:343-7.Google Scholar
353.Henderson, E, Ledgerwood, D, Hope, KM, et al. Prolonged and multipatient use of prefilled disposable oxygen humidifier bottles: safety and cost. Infect Control Hosp Epidemiol. 1993;14:463-8.Google Scholar
354.Food and Drug Administration. Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals. Rockville, MD: Food and Drug Administration; 2000.Google Scholar
355.Rosenfeld, M, Emerson, J, Astley, S, et al. Home nebulizer use among patients with cystic fibrosis. J Pediatr. 1998;132:125-31.Google Scholar
356.Vassal, S, Taamma, R, Marty, N, et al. Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis. Am J Infect Control. 2000;28:347-51.Google Scholar
357.Arnow, PM, Chou, T, Weil, D, Shapiro, EN, Kretzschmar, C. Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices. J Infect Dis. 1982;146:460-7.Google Scholar
358.Sheth, NK, Post, GT, Wisniewski, TR, Uttech, BV. Multidose vials versus single-dose vials: a study in sterility and cost-effectiveness. J Clin Microbiol. 1983;17:377-9.Google Scholar
359.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understating, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol. 1999;20:598603.Google Scholar
360.Cunha, BA, Klimek, JJ, Gracewski, J, McLaughlin, JC, Quintiliani, R. A common source outbreak of Acinetobacter pulmonary infections traced to Wright respirometers. Postgrad Med J. 1980;56:169-72.Google Scholar
361.Irwin, RS, Demers, RR, Pratter, MR, et al. An outbreak of Acinetobacter infection associated with the use of a ventilator spirometer. Respir Care. 1980;25:232-7.Google Scholar
362.Rutala, DR, Rutala, WA, Weber, DJ, Thomann, CA. Infection risks associated with spirometry. Infect Control Hosp Epidemiol. 1991;12:8992.Google Scholar
363.Rutala, WA, Weber, DJ. Surface disinfection: should we do it? J Hosp Infect. 2001;48:S64-68.Google Scholar
364.Roberts, FJ, Cockcroft, WH, Johnson, HE. A hot water disinfection method for inhalation therapy equipment. Can Med Assoc J. 1969;101:30-2.Google Scholar
365.Ayliffe, GA, Collins, BJ, Lowbury, EJ, Babb, JR, Lilly, HA. Ward floors and other surfaces as reservoirs of hospital infection. J Hyg (Lond). 1967;65:515-36.Google Scholar
366.Russell, AD, McDonnell, G. Concentration: a major factor in studying bio-cidal action. J Hosp Infect. 2000;44:13.Google Scholar
367.Rutala, WA, Cole, EC. Antiseptics and disinfectants—safe and effective? Infect Control. 1984;5:215-8.Google Scholar
368.Weber, DJ, Rutala, WA. Occupational risks associated with the use of selected disinfectants and sterilants. In: Rutala, WA ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:211226.Google Scholar
369.Regelmann, WE, Elliott, GR, Warwick, WJ, Clawson, CC. Reduction of sputum Pseudomonas aeruginosa density by antibiotics improves lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone. Am Rev Respir Dis. 1990;141:914-21.Google Scholar
370.Campos, JM. Culture and isolation. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:604-13.Google Scholar
371.Ziegler, T, Cox, NJ. Influenza viruses. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7 ed. Washington, DC: ASM Press; 1999:928-35.Google Scholar
372.Waner, JL. Parainfluenza viruses. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7 ed. Washington, DC: ASM Press; 1999:936-41.Google Scholar
373.Tristram, DA, Welliver, RC. Respiratory syncytial virus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:942-50.Google Scholar
374.Wadell, G, Allard, A, Hierholzer, JC. Adenoviruses. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1999:970-81.Google Scholar
375.Kiska, DL, Kerr, A, Jones, MC, et al. Accuracy of four commercial systems for identification of Burkholderia cepacia and other gram-negative nonfermenting bacilli recovered from patients with cystic fibrosis. J Clin Microbiol. 1996;34:886-91.Google Scholar
376.van Pelt, C, Verduin, CM, Goessens, WH, et al. Identification of Burkholderia spp. in the clinical microbiology laboratory: comparison of conventional and molecular methods. J Clin Microbiol. 1999;37:2158-64.Google Scholar
377.Shelly, DB, Spilker, T, Gracely, EJ, Coenye, T, Vandamme, P, LiPuma, JJ. Utility of commercial systems for identification of Burkholderia cepacia complex from cystic fibrosis sputum culture. J Clin Microbiol. 2000;38:3112-5.Google Scholar
378.American Institutes of Architects. Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington, DC: American Institute of Architects Press; 2001:15.Google Scholar
379.Guidelines for preventing the transmission of Mycobacteria tuberculosis in health-care facilities, 1994. MMWR Morb Mortal Wkly Rep. 1994;43:(RR-13):1132.Google Scholar
380.Centers for Disease Control and Prevention. Recommended childhood immunization schedule—United States, 2002. MMWR. 2002;51:3133.Google Scholar
381.Advisory Commiittee on Immunization Practice (ACIP). Preventing pneumococcal disease among infants and young children. Recommendations of the Advisory Committee on Immunization Practice(ACIP). MMWR Morb Mortal Wkly Rep. 2000;49:135.Google Scholar
382.Rutala, WA, Weber, DJ, Gergen, MF, Gratta, AR. Efficacy of a washer-pasteurizer for disinfection of respiratory-care equipment. Infect Control Hosp Epidemiol. 2000;21:333-6.Google Scholar
383.Latimer, JM, Matsen, JM. Microwave oven irradiation as a method for bacterial decontamination in a clinical microbiology laboratory. J Clin Microbiol. 1977;6:340-2.Google Scholar
384.Robbins, J, Cromwell, P, Korones, DN. Swimming and central venous catheter-related infections in the child with cancer. J Pediatr Oncol Nurs. 1999;16:51-6.Google Scholar
385.Howell, PB, Walters, PE, Donowitz, GR, Farr, BM. Risk factors for infection of adult patients with cancer who have tunnelled central venous catheters. Cancer. 1995;75:1367-75.Google Scholar
386.O'Grady, NP, Alexander, M, Delinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002;51(RR-10):129.Google Scholar
387.Evans, CE, Haynes, RB. Patient compliance. In: Rakel, RE, ed. Textbook of Family Practice. 4th ed. Philadelphia, PA: WB Saunders Co; 1990:371379.Google Scholar
388.Vandamme, P, Holmes, B, Vancanneyt, M, et al. Occurrence of multiple genomovars of Burkholderia cepacia in cystic fibrosis patients and proposal of Burkholderia multivorans sp. nov. Int J Syst Bacterial. 1997;47:1188-200.Google Scholar
389.Vandamme, P, Mahenthiralingam, E, Holmes, B, et al. Identification and population structure of Burkholderia stabilis sp. nov. (formerly Burkholderia cepacia genomovar IV). J Clin Microbiol. 2000;38:1042-7.Google Scholar
390.Gillis, M, Van, TV, Bardin, R. Polyphasic taxonomy in the genus Burkholderia leading to an emended description of the genus and proposition of Burkholderia vietnamiensis sp. nov. for N2-fixing isolates from rice in Vietnam. Int J Syst Bacterial. 1995;45:274.Google Scholar
391.Coenye, T, LiPuma, JJ, Henry, D, et al. Burkholderia cepacia genomovar VI, a new member of the Burkholderia cepacia complex isolated from cystic fibrosis patients. Int J Syst Evol Microbiol. 2001;51:271-9.Google Scholar
392.Coenye, T, Mahenthiralingam, E, Henry, D, et al. Burkholderia ambifaria sp. nov., a novel member of the Burkholderia cepacia complex including biocontrol and cystic fibrosis-related isolates. Int J Syst Evol Microbiol. 2001;51:1481-90.Google Scholar
393.Vandamme, P, Henry, D, Coenye, T, et al. Burkholderia anthina sp. nov. and Burkholderia pyrrocinia, two additional Burkholderia cepacia complex bacteria, may confound results of new molecular diagnostic tools. FEMS Immunol Med Microbiol. 2002;33:143-9.Google Scholar
394.Stableforth, DE, Smith, DL. Pseudomonas cepacia in cystic fibrosis. Thorax. 1994;49:629-30.Google Scholar
395.Weber, DJ, Rutala, WA. Role of environmental contamination in the transmission of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol. 1997;18:306-9.Google Scholar