Multi-drug resistant infection spreading globally among cystic fibrosis patients

17 November 2016

A multidrug resistant infection that can cause life-threatening illness in people with cystic fibrosis (CF) and can spread from patient to patient, has spread globally and is becoming increasingly virulent, according to researchers, including Jakko van Ingen, clinical microbiologist at Radboudumc, in a publication this week in the journal Science.

Mycobacterium abscessus, a species of multidrug resistant mycobacteria, can cause a severe pneumonia in CF patients leading to accelerated inflammatory damage to the lungs, and may prevent safe lung transplantation. It is extremely difficult to treat – only one in three cases is treated successfully. Their previous study in one CF center in the UK suggested person-to-person transmission of M. abscessus but it was unclear whether this was a one off incident. Now, by sequencing the whole genomes of over 1,000 isolates of mycobacteria from 517 individuals attending CF centers in Europe (including Radboudumc), the US and Australia, researchers have demonstrated that the majority of CF patients have acquired transmissible forms of M. abscessus that have spread globally. Further analysis suggests that the infection may be transmitted within hospitals via contaminated surfaces and through airborne transmission. This presents a potentially serious challenge to infection control practices in hospitals. Using a combination of cell-based and mouse models, the researchers showed that the transmissible M. abscessus clones were also more virulent. So, while M. abscessus initially entered the CF patient population from the environment, it seems to have recently evolved to become capable of jumping from patient to patient, getting more virulent as it does so. The question now is how the pathogen manages to spread globally. Around one in 2,500 children in the Netherlands is born with cystic fibrosis, a hereditary condition that causes the lungs to become clogged up with thick, sticky mucus and decreases life expectancy among patients. http://science.sciencemag.org/content/354/6313/751

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