Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada

Pseudomonas aeruginosa is the most common respiratory pathogen in patients with cystic fibrosis (CF), but the predominant mechanism by which it is acquired is controversial. To determine the frequency of patient-to-patient spread, we evaluated A aeruginosa isolates from 174 patients treated at the CIF clinics in Vancouver, BC, Canada, since 1981. Multiple isolates were obtained from each patient and genetically typed by random amplified polymorphic DNA and pulsed field gel electrophoresis analyses. A total of 157 genetic types of P. aeruginosa was identified, 123 of which were unique to individual patients. A total of 34 types was shared by more than one patient; epidemiologic evidence linked these individuals only in the cases of 10 sibships and I pair of unrelated patients. We conclude that there is an extremely low risk in Vancouver for patients with CIF to acquire P. aeruginosa from other Patients. It appears that prolonged close contact, such as occurs between siblings, is necessary for patient-to-patient spread. The major source of acquisition of P. aeruginosa in CIF appears to be from the environment. Considering these observations, we do not recommend segregation of patients with CIF on the basis of their colonization status with P. aeruginosa.