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Pseudomonas aeruginosa in children with cystic fibrosis diagnosed through newborn screening: Assessment of clinic exposures and microbial genotypes
Author(s) -
Hayes Don,
West Susan E.,
Rock Michael J.,
Li Zhanhai,
Splaingard Mark L.,
Farrell Philip M.
Publication year - 2010
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21263
Subject(s) - medicine , cystic fibrosis , pseudomonas aeruginosa , genotyping , genotype , pediatrics , newborn screening , hygiene , pathology , biochemistry , chemistry , genetics , bacteria , gene , biology
Background Chronic pulmonary infection with Pseudomonas aeruginosa (PA) is responsible for significant morbidity and mortality in cystic fibrosis (CF). Because of the limited studies evaluating early exposure and the progression of genetic variability of PA, our goal was to assess PA in young children with CF followed in two clinic types. Methods A total of 39 infants with CF diagnosed through newborn screening were randomly assigned to either a segregated (PA‐free) or mixed (PA‐positive) clinic at two different CF centers, one of which replaced an older, mixed clinic where nosocomial acquisition was suspected. Oropharyngeal (OP) swab cultures were examined with subsequent genotyping to characterize the strains of PA isolated. Results We found that 13/21 segregated clinic patients and 14/18 mixed clinic patients showed positive PA, with median acquisition ages of 3.3 and 2.2 years, respectively ( P = 0.57). The median time to PA acquisition, however, was significantly longer in the new clinic with proper hygiene precautions compared to an old site (5.0 years vs. 1.7 years, P < 0.001). The majority of subjects isolated a single genotype of PA or AP‐PCR types during the study period with eight subjects clearing the isolate after only one positive culture. The development of chronic colonization yielded the predominance of a single major genotype or AP‐PCR type. Conclusions Segregation of infants and young children with CF in PA‐negative or PA‐positive clinics did not alter the time to first PA isolation in this randomized assessment of facilities with hygienic precautions. During the early infection period where PA is first isolated in young children with CF, patients cleared different PA strains until a predominant strain established permanent colonization. Pediatr Pulmonol. 2010; 45:708–716. © 2010 Wiley‐Liss, Inc.