Isolation of infectious cystic fibrosis patients: results of a systematic review.

OBJECTIVE: Respiratory tract infections significantly contribute to morbidity and mortality among cystic fibrosis (CF) patients. Therefore, pathogen transmission needs to be prevented. There are several guidelines for the care of CF patients, but no transparent systematic literature review has been published.

METHODS: We conducted a systematic literature review (January 1966 to September 2004) dealing with segregation of CF patients colonized with Burkholderia cepacia species, Pandoraea species, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or Alcaligenes species. Quality of studies was evaluated by taking patient population size, existence of control-patients, patient randomization, diagnostic approach, and bacteria typing methods into account.

RESULTS: One hundred ninety-nine studies were found. Evidence and quality of 102 publications were evaluated. In 99 publications, recommendations concerning segregation measures for infectious CF patients were determined including a total of 11,576 patients. No randomized, controlled trials had been conducted. Fifty of 56 authors strongly recommended isolation of CF patients infected with B. cepacia or Pandoraea species. In 31 of 39 studies, interpatient spread of Pseudomonas aeruginosa was documented or had been brought to an end by isolation of patients. Only five studies had addressed S. maltophilia or Alcaligenes species.

CONCLUSIONS: Patients colonized with B. cepacia or Pandoraea species are to be separated from noncolonized patients in single rooms. Patients harboring multidrug-resistant Pseudomonas aeruginosa, S. maltophilia, or Alcaligenes species may not share a room with immunocompromised patients, in intensive care units, or with other CF patients anywhere in the hospital.