OUTCOME FOR PATIENTS COLONIZED WITH BURKHOLDERIA-CEPACIA IN A BIRMINGHAM ADULT CYSTIC-FIBROSIS CLINIC AND THE END OF AN EPIDEMIC

Background - There has been increasing concern since 1979 about the em ergence of Pseudomonas cepacia (Burkholderia cepacia) in patients with cystic fibrosis in the UK and elsewhere. Colonisation of the sputum h as been shown to be associated with increased morbidity and mortality. Evidence suggests person to person transmission and some centres have segregated those colonised with B cepacia from other patients with cy stic fibrosis. The outcome ofpatients colonised by B cepacia has been studied, together with the effects of strict segregation. Methods - Th e outcome in 18 patients with sputum colonised by B cepacia was compar ed with that in age, sex, and severity matched controls with no eviden ce of B cepacia colonisation by a retrospective case note study. Resul ts - No differences between cases or controls were found in the 24 mon th period prior to colonisation by B cepacia in lung function, number of days in hospital, or outpatient visits. Colonisation led to an incr eased rate of loss of lung function and utilisation of hospital servic es. There was an increase in the numbers of transplants and deaths amo ngst the cases. Since 1992 there have been only three new cases of B c epacia colonisation and the incidence and prevalence of the organism h as fallen dramatically since segregation commenced.Conclusions - B cep acia appears to be linked to the decline in colonised individuals. The re was no evidence that colonisation occurred in patients declining fo r other reasons. B cepacia colonisation confers a worse prognosis than Pseudomonas aeruginosa alone. Segregation appears to limit the spread of the organism from infected individuals to other patients with cyst ic fibrosis.