Skip to main content
    • Aa
    • Aa

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

  • Lisa Saiman (a1) (a2), Jane D. Siegel (a3) (a2), John J. LiPuma (a4) (a2), Rebekah F. Brown (a5), Elizabeth A. Bryson (a6), Mary Jo Chambers (a7), Veronica S. Downer (a8), Jill Fliege (a9), Leslie A. Hazle (a10), Manu Jain (a11), Bruce C. Marshall (a10), Catherine O’Malley (a12), Suzanne R. Pattee (a13), Gail Potter-Bynoe (a14), Siobhan Reid (a15), Karen A. Robinson (a16), Kathryn A. Sabadosa (a17), H. Joel Schmidt (a18), Elizabeth Tullis (a19), Jennifer Webber (a20) and David J. Weber (a21) (a22)...

The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:

1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.

2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.

Corresponding author
Columbia University, 622 West 168th Street, PH4 West Room 470, New York, NY 10032 (
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5. JD Siegel , E Rhinehart , M Jackson , L Chiarello . Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165S193.

6. JD Siegel , E Rhinehart , M Jackson , L Chiarello . 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65S164.

15. A Glatman-Freedman , I Portelli , SK Jacobs , et al. Attack rates assessment of the 2009 pandemic H1N1 influenza A in children and their contacts: a systematic review and meta-analysis. PLoS ONE 2012;7:e50228.

17. M Iwamoto , Y Mu , R Lynfield , et al. Trends in invasive methicillin-resistant Staphylococcus aureus infections. Pediatrics 2013;132:e817e824.

19. P Savard , TM Perl . A call for action: managing the emergence of multidrug-resistant Enterobacteriaceae in the acute care settings. Curr Opin Infect Dis 2012;25:371377.

20. JE Coia , GJ Duckworth , DI Edwards , et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl 1):S1S44.

22. EC Dasenbrook , CA Merlo , M Diener-West , N Lechtzin , MP Boyle . Persistent methicillin-resistant Staphylococcus aureus and rate of FEV1 decline in cystic fibrosis. Am J Respir Crit Care Med 2008;178:814821.

23. EC Dasenbrook , W Checkley , CA Merlo , MW Konstan , N Lechtzin , MP Boyle . Association between respiratory tract methicillin-resistant Staphylococcus aureus and survival in cystic fibrosis. JAMA 2010;303:23862392.

25. LA Kalish , DA Waltz , M Dovey , et al. Impact of Burkholderia dolosa on lung function and survival in cystic fibrosis. Am J Respir Crit Care Med 2006;173:421425.

26. JJ Lipuma . The changing microbial epidemiology in cystic fibrosis. Clin Microbiol Rev 2010;23:299323.

27. JL Fothergill , MJ Walshaw , C Winstanley . Transmissible strains of Pseudomonas aeruginosa in cystic fibrosis lung infections. Eur Respir J 2012;40:227238.

28. SD Aaron , KL Vandemheen , K Ramotar , et al. Infection with transmissible strains of Pseudomonas aeruginosa and clinical outcomes in adults with cystic fibrosis. JAMA 2010;304:21452153.

29. V Waters , JE Zlosnik , YC Yau , DP Speert , SD Aaron , DS Guttman . Comparison of three typing methods for Pseudomonas aeruginosa isolates from patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis 2012;31:33413350.

30. RA Luna , LA Millecker , CR Webb , et al. Molecular epidemiological surveillance of multidrug-resistant Pseudomonas aeruginosa isolates in a pediatric population of patients with cystic fibrosis and determination of risk factors for infection with the Houston-1 strain. J Clin Microbiol 2013;51:12371240.

31. JS Elborn . Fixing cystic fibrosis CFTR with correctors and potentiators: off to a good start. Thorax 2012;67:45.

32. KA Robinson , IJ Saldanha , NA McKoy . Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol 2011;64:13251330.

33. DB Petitti , SM Teutsch , MB Barton , GF Sawaya , JK Ockene , T DeWitt . Update on the methods of the U.S. Preventive Services Task Force: insufficient evidence. Ann Intern Med 2009;150:199205.

34. GF Sawaya , J Guirguis-Blake , M LeFevre , R Harris , D Petitti . Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Ann Intern Med 2007;147:871875.

35. GH Guyatt , AD Oxman , GE Vist , et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924926.

36. F Ahmed , JL Temte , D Campos-Outcalt , HJ Schunemann . Methods for developing evidence-based recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC). Vaccine 2011;29:91719176.

37. CA Umscheid , RK Agarwal , PJ Brennan . Updating the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 2010;38:264273.

38. MR Griffin . Influenza vaccination of healthcare workers: making the grade for action. Clin Infect Dis 2014;58:5860.

39. MB Miller , PH Gilligan . Laboratory aspects of management of chronic pulmonary infections in patients with cystic fibrosis. J Clin Microbiol 2003;41:40094015.

41. J Zhou , E Garber , M Desai , L Saiman . Compliance of clinical microbiology laboratories in the United States with current recommendations for processing respiratory tract specimens from patients with cystic fibrosis. J Clin Microbiol 2006;44:15471549.

42. M Rosenfeld , J Emerson , F Accurso , et al. Diagnostic accuracy of oropharyngeal cultures in infants and young children with cystic fibrosis. Pediatr Pulmonol 1999;28:321328.

43. S Al-Saleh , SD Dell , H Grasemann , et al. Sputum induction in routine clinical care of children with cystic fibrosis. J Pediatr 2010;157:1006.e1–1011.e1.

44. S Razvi , L Quittell , A Sewall , H Quinton , B Marshall , L Saiman . Respiratory microbiology of patients with cystic fibrosis in the United States, 1995 to 2005. Chest 2009;136:15541560.

45. AG Davidson , MA Chilvers , YP Lillquist . Effects of a Pseudomonas aeruginosa eradication policy in a cystic fibrosis clinic. Curr Opin Pulm Med 2012;18:615621.

46. K Alby , PH Gilligan , MB Miller . Comparison of matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry platforms for the identification of gram-negative rods from patients with cystic fibrosis. J Clin Microbiol 2013;51:38523854.

47. AP Desai , T Stanley , M Atuan , et al. Use of matrix assisted laser desorption ionisation–time of flight mass spectrometry in a paediatric clinical laboratory for identification of bacteria commonly isolated from cystic fibrosis patients. J Clin Pathol 2012;65:835838.

48. A Fernandez-Olmos , M Garcia-Castillo , MI Morosini , A Lamas , L Maiz , R Canton . MALDI-TOF MS improves routine identification of non-fermenting gram negative isolates from cystic fibrosis patients. J Cyst Fibros 2012;11:5962.

49. MN Hurley , AH Ariff , C Bertenshaw , J Bhatt , AR Smyth . Results of antibiotic susceptibility testing do not influence clinical outcome in children with cystic fibrosis. J Cyst Fibros 2012;11:288292.

50. D Macdonald , L Cuthbertson , C Doherty , et al. Early Pseudomonas aeruginosa infection in individuals with cystic fibrosis: is susceptibility testing justified? J Antimicrob Chemother 2010;65:23732375.

51. K Cheng , RL Smyth , JR Govan , et al. Spread of β-lactam-resistant Pseudomonas aeruginosa in a cystic fibrosis clinic. Lancet 1996;348:639642.

52. M Denton , K Kerr , L Mooney , et al. Transmission of colistin-resistant Pseudomonas aeruginosa between patients attending a pediatric cystic fibrosis center. Pediatr Pulmonol 2002;34:257261.

53. AM Jones , JR Govan , CJ Doherty , et al. Spread of a multiresistant strain of Pseudomonas aeruginosa in an adult cystic fibrosis clinic. Lancet 2001;358:557558.

54. SV Lynch , KD Bruce . The cystic fibrosis airway microbiome. Cold Spring Harb Perspect Med 2013;3:a009738.

55. HR Rabin , MG Surette . The cystic fibrosis airway microbiome. Curr Opin Pulm Med 2012;18:622627.

56. ET Zemanick , SD Sagel , JK Harris . The airway microbiome in cystic fibrosis and implications for treatment. Curr Opin Pediatr 2011;23:319324.

57. J Zhao , PD Schloss , LM Kalikin , et al. Decade-long bacterial community dynamics in cystic fibrosis airways. Proc Natl Acad Sci USA 2012;109:58095814.

58. JJ Lipuma . Molecular tools for epidemiologic study of infectious diseases. Pediatr Infect Dis J 1998;17:667675.

59. AS Morel , L Saiman . The role of molecular epidemiologic typing in pediatric infection control. Semin Pediatr Infect Dis 2001;12:100106.

63. R Urwin , MC Maiden . Multi-locus sequence typing: a tool for global epidemiology. Trends Microbiol 2003;11:479487.

65. ES Snitkin , AM Zelazny , PJ Thomas , et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med 2012;4:148ra116.

66. JM Bryant , DM Grogono , D Greaves , et al. Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystic fibrosis: a retrospective cohort study. Lancet 2013;381:15511560.

70. T Coenye , E Mahenthiralingam , D Henry , et al. Burkholderia ambifaria sp. nov., a novel member of the Burkholderia cepacia complex including biocontrol and cystic fibrosis–related isolates. Int J Syst Evol Microbiol 2001;51:14811490.

71. P Vandamme , D Henry , T Coenye , et al. Burkholderia anthina sp. nov. and Burkholderia pyrrocinia, two additional Burkholderia cepacia complex bacteria, may confound results of new molecular diagnostic tools. FEMS Immunol Med Microbiol 2002;33:143149.

72. E Vanlaere , A Baldwin , D Gevers , et al. Taxon K, a complex within the Burkholderia cepacia complex, comprises at least two novel species, Burkholderia contaminans sp. nov. and Burkholderia lata sp. nov. Int J Syst Evol Microbiol 2009;59:102111.

73. P Vandamme , B Holmes , T Coenye , et al. Burkholderia cenocepacia sp. nov.—a new twist to an old story. Res Microbiol 2003;154:9196.

74. P Vandamme , B Holmes , M Vancanneyt , et al. Occurrence of multiple genomovars of Burkholderia cepacia in cystic fibrosis patients and proposal of Burkholderia multivorans sp. nov. Int J Syst Bacteriol 1997;47:11881200.

76. E Vanlaere , JJ Lipuma , A Baldwin , et al. Burkholderia latens sp. nov., Burkholderia diffusa sp. nov., Burkholderia arboris sp. nov., Burkholderia seminalis sp. nov. and Burkholderia metallica sp. nov., novel species within the Burkholderia cepacia complex. Int J Syst Evol Microbiol 2008;58:15801590.

77. E Yabuuchi , Y Kawamura , T Ezaki , et al. Burkholderia uboniae sp. nov., L-arabinose-assimilating but different from Burkholderia thailandensis and Burkholderia vietnamiensis. Microbiol Immunol 2000;44:307317.

78. C Peeters , JE Zlosnik , T Spilker , TJ Hird , JJ Lipuma , P Vandamme . Burkholderia pseudomultivorans sp. nov., a novel Burkholderia cepacia complex species from human respiratory samples and the rhizosphere. Syst Appl Microbiol 2013;36:483489.

79. K Vermis , T Coenye , JJ LiPuma , E Mahenthiralingam , HJ Nelis , P Vandamme . Proposal to accommodate Burkholderia cepacia genomovar VI as Burkholderia dolosa sp. nov. Int J Syst Evol Microbiol 2004;54:689691.

80. M Gillis , V Tran Van , R Bardin , et al. Polyphasic taxonomy in the genus Burkholderia leading to an emended description of the genus and proposition of Burkholderia vietnamiensis sp. nov. for N2-fixing isolates from rice in Vietnam. Int J Syst Bacteriol 1995;45:274.

81. JJ Lipuma . Update on the Burkholderia cepacia complex. Curr Opin Pulm Med 2005;11:528533.

83. O Ciofu , CR Hansen , N Hoiby . Respiratory bacterial infections in cystic fibrosis. Curr Opin Pulm Med 2013;19:251258.

84. AL Prunier , B Malbruny , M Laurans , J Brouard , JF Duhamel , R Leclercq . High rate of macrolide resistance in Staphylococcus aureus strains from patients with cystic fibrosis reveals high proportions of hypermutable strains. J Infect Dis 2003;187:17091716.

85. S Besier , J Zander , BC Kahl , P Kraiczy , V Brade , TA Wichelhaus . The thymidine-dependent small-colony-variant phenotype is associated with hypermutability and antibiotic resistance in clinical Staphylococcus aureus isolates. Antimicrob Agents Chemother 2008;52:21832189.

86. RA Proctor , C von Eiff , BC Kahl , et al. Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol 2006;4:295305.

87. RA Proctor , B Kahl , C von Eiff , PE Vaudaux , DP Lew , G Peters . Staphylococcal small colony variants have novel mechanisms for antibiotic resistance. Clin Infect Dis 1998;27(suppl 1):S68S74.

88. B Sadowska , A Bonar , C von Eiff , et al. Characteristics of Staphylococcus aureus, isolated from airways of cystic fibrosis patients, and their small colony variants. FEMS Immunol Med Microbiol 2002;32:191197.

89. G Mitchell , G Grondin , G Bilodeau , AM Cantin , F Malouin . Infection of polarized airway epithelial cells by normal and small-colony variant strains of Staphylococcus aureus is increased in cells with abnormal cystic fibrosis transmembrane conductance regulator function and is influenced by NF-κB. Infect Immun 2011;79:35413551.

90. RA Proctor , P van Langevelde , M Kristjansson , JN Maslow , RD Arbeit . Persistent and relapsing infections associated with small-colony variants of Staphylococcus aureus. Clin Infect Dis 1995;20:95102.

91. BC Kahl , A Duebbers , G Lubritz , et al. Population dynamics of persistent Staphylococcus aureus isolated from the airways of cystic fibrosis patients during a 6-year prospective study. J Clin Microbiol 2003;41:44244427.

92. S Besier , C Smaczny , C von Mallinckrodt , et al. Prevalence and clinical significance of Staphylococcus aureus small-colony variants in cystic fibrosis lung disease. J Clin Microbiol 2007;45:168172.

93. M Schneider , K Muhlemann , S Droz , S Couzinet , C Casaulta , S Zimmerli . Clinical characteristics associated with isolation of small-colony variants of Staphylococcus aureus and Pseudomonas aeruginosa from respiratory secretions of patients with cystic fibrosis. J Clin Microbiol 2008;46:18321834.

94. LR Hoffman , E Deziel , DA D’Argenio , et al. Selection for Staphylococcus aureus small-colony variants due to growth in the presence of Pseudomonas aeruginosa. Proc Natl Acad Sci USA 2006;103:19890–19895.

95. DJ Wolter , JC Emerson , S McNamara , et al. Staphylococcus aureus small-colony variants are independently associated with worse lung disease in children with cystic fibrosis. Clin Infect Dis 2013;57:384391.

96. MJ Kirisits , L Prost , M Starkey , MR Parsek . Characterization of colony morphology variants isolated from Pseudomonas aeruginosa biofilms. Appl Environ Microbiol 2005;71:48094821.

97. SW Anderson , JR Stapp , JL Burns , X Qin . Characterization of small-colony-variant Stenotrophomonas maltophilia isolated from the sputum specimens of five patients with cystic fibrosis. J Clin Microbiol 2007;45:529535.

99. SH Kasperbauer , CL Daley . Diagnosis and treatment of infections due to Mycobacterium avium complex. Semin Respir Crit Care Med 2008;29:569576.

100. T Adekambi , P Berger , D Raoult , M Drancourt . rpoB gene sequence–based characterization of emerging nontuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov., Mycobacterium phocaicum sp. nov. and Mycobacterium aubagnense sp. nov. Int J Syst Evol Microbiol 2006;56:133143.

101. T Adekambi , M Reynaud-Gaubert , G Greub , et al. Amoebal coculture of “Mycobacterium massiliense” sp. nov. from the sputum of a patient with hemoptoic pneumonia. J Clin Microbiol 2004;42:54935501.

102. KN Olivier , DJ Weber , RJ Wallace Jr, et al. Nontuberculous mycobacteria. I. Multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 2003;167:828834.

103. I Levy , G Grisaru-Soen , L Lerner-Geva , et al. Multicenter cross-sectional study of nontuberculous mycobacterial infections among cystic fibrosis patients, Israel. Emerg Infect Dis 2008;14:378384.

104. AL Roux , E Catherinot , F Ripoll , et al. Multicenter study of prevalence of nontuberculous mycobacteria in patients with cystic fibrosis in France. J Clin Microbiol 2009;47:41244128.

105. M Pihet , J Carrere , B Cimon , et al. Occurrence and relevance of filamentous fungi in respiratory secretions of patients with cystic fibrosis—a review. Med Mycol 2009;47:387397.

106. SN Bains , MA Judson . Allergic bronchopulmonary aspergillosis. Clin Chest Med 2012;33:265281.

107. AP Knutsen , RG Slavin . Allergic bronchopulmonary aspergillosis in asthma and cystic fibrosis. Clin Dev Immunol 2011;2011:843763.

108. M Kousha , R Tadi , AO Soubani . Pulmonary aspergillosis: a clinical review. Eur Respir Rev 2011;20:156174.

109. RB Moss . Allergic bronchopulmonary aspergillosis and Aspergillus infection in cystic fibrosis. Curr Opin Pulm Med 2010;16:598603.

110. JC Liu , DE Modha , EA Gaillard . What is the clinical significance of filamentous fungi positive sputum cultures in patients with cystic fibrosis? J Cyst Fibros 2013;12:187193.

113. SF Dowell , JM Simmerman , DD Erdman , et al. Severe acute respiratory syndrome coronavirus on hospital surfaces. Clin Infect Dis 2004;39:652657.

114. WE Bischoff , K Swett , I Leng , TR Peters . Exposure to influenza virus aerosols during routine patient care. J Infect Dis 2013;207:10371046.

116. K Tran , K Cimon , M Severn , CL Pessoa-Silva , J Conly . Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS ONE 2012;7:e35797.

117. CJ Roy , DK Milton . Airborne transmission of communicable infection—the elusive pathway. N Engl J Med 2004;350:17101712.

118. TW Wong , CK Lee , W Tam , et al. Cluster of SARS among medical students exposed to single patient, Hong Kong. Emerg Infect Dis 2004;10:269276.

119. IJ Clifton , LA Fletcher , CB Beggs , M Denton , SP Conway , DG Peckham . An aerobiological model of aerosol survival of different strains of Pseudomonas aeruginosa isolated from people with cystic fibrosis. J Cyst Fibros 2010;9:6468.

120. F Festini , G Taccetti , V Galici , et al. A 1-m distance is not safe for children with cystic fibrosis at risk for cross-infection with Pseudomonas aeruginosa. Am J Infect Control 2010;38:244245.

121. CE Wainwright , MW France , P O’Rourke , et al. Cough-generated aerosols of Pseudomonas aeruginosa and other gram-negative bacteria from patients with cystic fibrosis. Thorax 2009;64:926931.

122. IJ Clifton , DG Peckham . Defining routes of airborne transmission of Pseudomonas aeruginosa in people with cystic fibrosis. Expert Rev Respir Med 2010;4:519529.

123. IH Spicknall , JS Koopman , M Nicas , JM Pujol , S Li , JN Eisenberg . Informing optimal environmental influenza interventions: how the host, agent, and environment alter dominant routes of transmission. PLoS Comput Biol 2010;6:e1000969.

124. G Brankston , L Gitterman , Z Hirji , C Lemieux , M Gardam . Transmission of influenza A in human beings. Lancet Infect Dis 2007;7:257265.

126. A Ferroni , A Werkhauser-Bertrand , M Le Bourgeois , et al. Bacterial contamination in the environment of hospitalised children with cystic fibrosis. J Cyst Fibros 2008;7:477482.

127. S Panagea , C Winstanley , MJ Walshaw , MJ Ledson , CA Hart . Environmental contamination with an epidemic strain of Pseudomonas aeruginosa in a Liverpool cystic fibrosis centre, and study of its survival on dry surfaces. J Hosp Infect 2005;59:102107.

128. JB Zuckerman , DE Zuaro , BS Prato , et al. Bacterial contamination of cystic fibrosis clinics. J Cyst Fibros 2009;8:186192.

129. ML Aitken , A Limaye , P Pottinger , et al. Respiratory outbreak of Mycobacterium abscessus subspecies massiliense in a lung transplant and cystic fibrosis center. Am J Respir Crit Care Med 2012;185:231232.

130. DP Speert , ME Campbell , DA Henry , et al. Epidemiology of Pseudomonas aeruginosa in cystic fibrosis in British Columbia, Canada. Am J Respir Crit Care Med 2002;166:988993.

131. L Jelsbak , HK Johansen , AL Frost , et al. Molecular epidemiology and dynamics of Pseudomonas aeruginosa populations in lungs of cystic fibrosis patients. Infect Immun 2007;75:22142224.

133. R Biddick , T Spilker , A Martin , JJ LiPuma . Evidence of transmission of Burkholderia cepacia, Burkholderia multivorans and Burkholderia dolosa among persons with cystic fibrosis. FEMS Microbiol Lett 2003;228:5762.

134. JJ LiPuma , SE Dasen , DW Nielson , RC Stern , TL Stull . Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis. Lancet 1990;336:10941096.

135. JR Govan , PH Brown , J Maddison , et al. Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis. Lancet 1993;342:1519.

137. A Elizur , RC Orscheln , TW Ferkol , WM Dunne Jr, GA Storch , CL Cannon . Transmission of Panton-Valentine leukocidin–positive Staphylococcus aureus between patients with cystic fibrosis. J Pediatr 2007;151:9092.

138. R Givney , A Vickery , A Holliday , M Pegler , R Benn . Methicillin-resistant Staphylococcus aureus in a cystic fibrosis unit. J Hosp Infect 1997;35:2736.

139. P Cocchi , L Cariani , F Favari , et al. Molecular epidemiology of meticillin-resistant Staphylococcus aureus in Italian cystic fibrosis patients: a national overview. J Cyst Fibros 2011;10:407411.

143. JW Krzewinski , CD Nguyen , JM Foster , JL Burns . Use of random amplified polymorphic DNA PCR to examine epidemiology of Stenotrophomonas maltophilia and Achromobacter (Alcaligenes) xylosoxidans from patients with cystic fibrosis. J Clin Microbiol 2001;39:35973602.

144. S Van Daele , R Verhelst , G Claeys , et al. Shared genotypes of Achromobacter xylosoxidans strains isolated from patients at a cystic fibrosis rehabilitation center. J Clin Microbiol 2005;43:29983002.

145. KA Harris , DT Kenna , C Blauwendraat , et al. Molecular fingerprinting of Mycobacterium abscessus strains in a cohort of pediatric cystic fibrosis patients. J Clin Microbiol 2012;50:17581761.

146. A Baldwin , E Mahenthiralingam , KM Thickett , et al. Multilocus sequence typing scheme that provides both species and strain differentiation for the Burkholderia cepacia complex. J Clin Microbiol 2005;43:46654673.

147. T Coenye , JJ LiPuma . Multilocus restriction typing: a novel tool for studying global epidemiology of Burkholderia cepacia complex infection in cystic fibrosis. J Infect Dis 2002;185:14541462.

149. JJ LiPuma , JE Mortensen , SE Dasen , et al. Ribotype analysis of Pseudomonas cepacia from cystic fibrosis treatment centers. J Pediatr 1988;113:859862.

150. T Spilker , A Baldwin , A Bumford , CG Dowson , E Mahenthiralingam , JJ LiPuma . Expanded multilocus sequence typing for Burkholderia species. J Clin Microbiol 2009;47:26072610.

151. DA Pegues , LA Carson , OC Tablan , et al; Summer Camp Study Group. Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. J Pediatr 1994;124:694702.

153. TL Pitt , ME Kaufmann , PS Patel , LC Benge , S Gaskin , DM Livermore . Type characterisation and antibiotic susceptibility of Burkholderia (Pseudomonas) cepacia isolates from patients with cystic fibrosis in the United Kingdom and the Republic of Ireland. J Med Microbiol 1996;44:203210.

154. JS Chen , KA Witzmann , T Spilker , RJ Fink , JJ LiPuma . Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis. J Pediatr 2001;139:643649.

155. T Coenye , JJ LiPuma . Population structure analysis of Burkholderia cepacia genomovar III: varying degrees of genetic recombination characterize major clonal complexes. Microbiology 2003;149:7788.

156. A Kumar , S Dietrich , W Schneider , et al. Genetic relatedness of Burkholderia (Pseudomonas) cepacia isolates from five cystic fibrosis centers in Michigan. Respir Med 1997;91:485492.

157. AC Springman , JL Jacobs , VS Somvanshi , et al. Genetic diversity and multihost pathogenicity of clinical and environmental strains of Burkholderia cenocepacia. Appl Environ Microbiol 2009;75:52505260.

158. P Drevinek , S Vosahlikova , O Cinek , et al. Widespread clone of Burkholderia cenocepacia in cystic fibrosis patients in the Czech Republic. J Med Microbiol 2005;54:655659.

159. E Mahenthiralingam , P Vandamme , ME Campbell , et al. Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans. Clin Infect Dis 2001;33:14691475.

160. DP Speert , D Henry , P Vandamme , M Corey , E Mahenthiralingam . Epidemiology of Burkholderia cepacia complex in patients with cystic fibrosis, Canada. Emerg Infect Dis 2002;8:181187.

161. S Campana , G Taccetti , N Ravenni , et al. Transmission of Burkholderia cepacia complex: evidence for new epidemic clones infecting cystic fibrosis patients in Italy. J Clin Microbiol 2005;43:51365142.

162. G Manno , C Dalmastri , S Tabacchioni , et al. Epidemiology and clinical course of Burkholderia cepacia complex infections, particularly those caused by different Burkholderia cenocepacia strains, among patients attending an Italian cystic fibrosis center. J Clin Microbiol 2004;42:14911497.

163. P Drevinek , O Cinek , J Melter , L Langsadl , Y Navesnakova , V Vavrova . Genomovar distribution of the Burkholderia cepacia complex differs significantly between Czech and Slovak patients with cystic fibrosis. J Med Microbiol 2003;52:603604.

165. ML Whiteford , JD Wilkinson , JH McColl , et al. Outcome of Burkholderia (Pseudomonas) cepacia colonisation in children with cystic fibrosis following a hospital outbreak. Thorax 1995;50:11941198.

166. JR Govan , AR Brown , AM Jones . Evolving epidemiology of Pseudomonas aeruginosa and the Burkholderia cepacia complex in cystic fibrosis lung infection. Future Microbiol 2007;2:153164.

167. JE Mortensen , MC Fisher , JJ LiPuma . Recovery of Pseudomonas cepacia and other Pseudomonas species from the environment. Infect Control Hosp Epidemiol 1995;16:3032.

168. HK Johansen , TA Kovesi , C Koch , M Corey , N Hoiby , H Levison . Pseudomonas aeruginosa and Burkholderia cepacia infection in cystic fibrosis patients treated in Toronto and Copenhagen. Pediatr Pulmonol 1998;26:8996.

169. M Corey , V Farewell . Determinants of mortality from cystic fibrosis in Canada, 1970–1989. Am J Epidemiol 1996;143:10071017.

170. M Rosenfeld , R Davis , S FitzSimmons , M Pepe , B Ramsey . Gender gap in cystic fibrosis mortality. Am J Epidemiol 1997;145:794803.

171. S Murray , J Charbeneau , BC Marshall , JJ LiPuma . Impact of Burkholderia infection on lung transplantation in cystic fibrosis. Am J Respir Crit Care Med 2008;178:363371.

172. A De Soyza , K Morris , A McDowell , et al. Prevalence and clonality of Burkholderia cepacia complex genomovars in UK patients with cystic fibrosis referred for lung transplantation. Thorax 2004;59:526528.

173. FW Scott , TL Pitt . Identification and characterization of transmissible Pseudomonas aeruginosa strains in cystic fibrosis patients in England and Wales. J Med Microbiol 2004;53:609615.

174. U Romling , B Fiedler , J Bosshammer , et al. Epidemiology of chronic Pseudomonas aeruginosa infections in cystic fibrosis. J Infect Dis 1994;170:16161621.

178. SS Pedersen , C Koch , N Hoiby , K Rosendal . An epidemic spread of multiresistant Pseudomonas aeruginosa in a cystic fibrosis centre. J Antimicrob Chemother 1986;17:505516.

179. MR O’Carroll , MW Syrmis , CE Wainwright , et al. Clonal strains of Pseudomonas aeruginosa in paediatric and adult cystic fibrosis units. Eur Respir J 2004;24:101106.

180. D Armstrong , S Bell , M Robinson , et al. Evidence for spread of a clonal strain of Pseudomonas aeruginosa among cystic fibrosis clinics. J Clin Microbiol 2003;41:22662267.

181. DS Armstrong , GM Nixon , R Carzino , et al. Detection of a widespread clone of Pseudomonas aeruginosa in a pediatric cystic fibrosis clinic. Am J Respir Crit Care Med 2002;166:983987.

182. MW Syrmis , MR O’Carroll , TP Sloots , et al. Rapid genotyping of Pseudomonas aeruginosa isolates harboured by adult and paediatric patients with cystic fibrosis using repetitive-element-based PCR assays. J Med Microbiol 2004;53:10891096.

183. R Bradbury , A Champion , DW Reid . Poor clinical outcomes associated with a multi-drug resistant clonal strain of Pseudomonas aeruginosa in the Tasmanian cystic fibrosis population. Respirology 2008;13:886892.

184. R van Mansfeld , R Willems , R Brimicombe , et al. Pseudomonas aeruginosa genotype prevalence in Dutch cystic fibrosis patients and age dependency of colonization by various P. aeruginosa sequence types. J Clin Microbiol 2009;47:40964101.

185. AL Griffiths , K Jamsen , JB Carlin , et al. Effects of segregation on an epidemic Pseudomonas aeruginosa strain in a cystic fibrosis clinic. Am J Respir Crit Care Med 2005;171:10201025.

186. A Ashish , M Shaw , C Winstanley , MJ Ledson , MJ Walshaw . Increasing resistance of the Liverpool epidemic strain (LES) of Pseudomonas aeruginosa (Psa) to antibiotics in cystic fibrosis (CF)—a cause for concern? J Cyst Fibros 2012;11:173179.

187. M Al-Aloul , J Crawley , C Winstanley , CA Hart , MJ Ledson , MJ Walshaw . Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients. Thorax 2004;59:334336.

188. AM Jones , ME Dodd , CJ Doherty , JR Govan , AK Webb . Increased treatment requirements of patients with cystic fibrosis who harbour a highly transmissible strain of Pseudomonas aeruginosa. Thorax 2002;57:924925.

189. A Ashish , M Shaw , J McShane , MJ Ledson , MJ Walshaw . Health-related quality of life in cystic fibrosis patients infected with transmissible Pseudomonas aeruginosa strains: cohort study. JRSM Short Rep 2012;3:12.

190. T Spilker , P Vandamme , JJ Lipuma . Identification and distribution of Achromobacter species in cystic fibrosis. J Cyst Fibros 2013;12:298301.

192. JH Weitkamp , YW Tang , DW Haas , NK Midha , JE Crowe Jr. Recurrent Achromobacter xylosoxidans bacteremia associated with persistent lymph node infection in a patient with hyper-immunoglobulin M syndrome. Clin Infect Dis 2000;31:11831187.

193. JM Duggan , SJ Goldstein , CE Chenoweth , CA Kauffman , SF Bradley . Achromobacter xylosoxidans bacteremia: report of four cases and review of the literature. Clin Infect Dis 1996;23:569576.

194. WM Dunne Jr, S Maisch . Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction. Clin Infect Dis 1995;20:836841.

195. H Vu-Thien , D Moissenet , M Valcin , C Dulot , G Tournier , A Garbarg-Chenon . Molecular epidemiology of Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans in a cystic fibrosis center. Eur J Clin Microbiol Infect Dis 1996;15:876879.

196. M Kanellopoulou , S Pournaras , H Iglezos , N Skarmoutsou , E Papafrangas , AN Maniatis . Persistent colonization of nine cystic fibrosis patients with an Achromobacter (Alcaligenes) xylosoxidans clone. Eur J Clin Microbiol Infect Dis 2004;23:336339.

197. T Coenye , T Spilker , R Reik , P Vandamme , JJ Lipuma . Use of PCR analyses to define the distribution of Ralstonia species recovered from patients with cystic fibrosis. J Clin Microbiol 2005;43:34633466.

198. T Coenye , P Vandamme , JJ LiPuma . Infection by Ralstonia species in cystic fibrosis patients: identification of R. pickettii and R. mannitolilytica by polymerase chain reaction. Emerg Infect Dis 2002;8:692696.

199. P Vandamme , T Coenye . Taxonomy of the genus Cupriavidus: a tale of lost and found. Int J Syst Evol Microbiol 2004;54:22852289.

200. P Vandamme , J Goris , T Coenye , et al. Assignment of Centers for Disease Control group IVc-2 to the genus Ralstonia as Ralstonia paucula sp. nov. Int J Syst Bacteriol 1999;49(pt 2):663669.

201. T Coenye , E Falsen , M Vancanneyt , et al. Classification of Alcaligenes faecalis–like isolates from the environment and human clinical samples as Ralstonia gilardii sp. nov. Int J Syst Bacteriol 1999;49(pt 2):405413.

202. T Coenye , P Vandamme , JJ LiPuma . Ralstonia respiraculi sp. nov., isolated from the respiratory tract of cystic fibrosis patients. Int J Syst Evol Microbiol 2003;53:13391342.

203. WM Chen , S Laevens , TM Lee , et al. Ralstonia taiwanensis sp. nov., isolated from root nodules of Mimosa species and sputum of a cystic fibrosis patient. Int J Syst Evol Microbiol 2001;51:17291735.

205. T Coenye , E Falsen , B Hoste , et al. Description of Pandoraea gen. nov. with Pandoraea apista sp. nov., Pandoraea pulmonicola sp. nov., Pandoraea pnomenusa sp. nov., Pandoraea sputorum sp. nov. and Pandoraea norimbergensis comb. nov. Int J Syst Evol Microbiol 2000;50(pt 2):887899.

206. IM Jorgensen , HK Johansen , B Frederiksen , et al. Epidemic spread of Pandoraea apista, a new pathogen causing severe lung disease in cystic fibrosis patients. Pediatr Pulmonol 2003;36:439446.

207. RJ Gorwitz , D Kruszon-Moran , SK McAllister , et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis 2008;197:12261234.

208. M Rosenfeld , C Bernardo-Ocampo , J Emerson , A Genatossio , J Burns , R Gibson . Prevalence of cystic fibrosis pathogens in the oropharynx of healthy children and implications for cystic fibrosis care. J Cyst Fibros 2012;11:456457.

209. C Goerke , K Kraning , M Stern , G Doring , K Botzenhart , C Wolz . Molecular epidemiology of community-acquired Staphylococcus aureus in families with and without cystic fibrosis patients. J Infect Dis 2000;181:984989.

210. TM Perl , JJ Cullen , RP Wenzel , et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:18711877.

212. C von Eiff , K Becker , K Machka , H Stammer , G Peters . Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:1116.

213. C Branger , C Gardye , N Lambert-Zechovsky . Persistence of Staphylococcus aureus strains among cystic fibrosis patients over extended periods of time. J Med Microbiol 1996;45:294301.

214. HF Wertheim , MC Vos , A Ott , et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004;364:703705.

215. A Stone , L Quittell , J Zhou , et al. Staphylococcus aureus nasal colonization among pediatric cystic fibrosis patients and their household contacts. Pediatr Infect Dis J 2009;28:895899.

216. S Ridder-Schaphorn , F Ratjen , A Dubbers , et al. Nasal Staphylococcus aureus carriage is not a risk factor for lower-airway infection in young cystic fibrosis patients. J Clin Microbiol 2007;45:29792984.

217. K Nadesalingam , SP Conway , M Denton . Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by patients with cystic fibrosis. J Cyst Fibros 2005;4:4952.

218. D Glikman , JD Siegel , MZ David , et al. Complex molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates from children with cystic fibrosis in the era of epidemic community-associated methicillin-resistant S aureus. Chest 2008;133:13811387.

219. MS Muhlebach , M Miller , LM LaVange , G Mayhew , JS Goodrich , MB Miller . Treatment intensity and characteristics of MRSA infection in CF. J Cyst Fibros 2011;10:201206.

220. EA Champion , MB Miller , EB Popowitch , MM Hobbs , L Saiman , MS Muhlebach . Antimicrobial susceptibility and molecular typing of MRSA in cystic fibrosis. Pediatr Pulmonol 2014;49:230237.

221. D Al-Zubeidi , PG Hogan , M Boyle , CA Burnham , SA Fritz . Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated in serial cultures from the respiratory tract of children with cystic fibrosis. Pediatr Infect Dis J 2014;33:549553.

222. SR Harris , EJ Cartwright , ME Torok , et al. Whole-genome sequencing for analysis of an outbreak of meticillin-resistant Staphylococcus aureus: a descriptive study. Lancet Infect Dis 2013;13:130136.

223. CU Koser , MT Holden , MJ Ellington , et al. Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak. N Engl J Med 2012;366:22672275.

224. E Vanderhelst , L De Meirleir , S Verbanck , D Pierard , W Vincken , A Malfroot . Prevalence and impact on FEV1 decline of chronic methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients with cystic fibrosis: a single-center, case control study of 165 patients. J Cyst Fibros 2012;11:27.

225. DB Sanders , RC Bittner , M Rosenfeld , GJ Redding , CH Goss . Pulmonary exacerbations are associated with subsequent FEV1 decline in both adults and children with cystic fibrosis. Pediatr Pulmonol 2011;46:393400.

226. GS Sawicki , L Rasouliyan , DJ Pasta , et al. The impact of incident methicillin resistant Staphylococcus aureus detection on pulmonary function in cystic fibrosis. Pediatr Pulmonol 2008;43:11171123.

227. FC Bange , BA Brown , C Smaczny , RJ Wallace Jr, EC Bottger . Lack of transmission of Mycobacterium abscessus among patients with cystic fibrosis attending a single clinic. Clin Infect Dis 2001;32:16481650.

228. BE Jonsson , M Gilljam , A Lindblad , M Ridell , AE Wold , C Welinder-Olsson . Molecular epidemiology of Mycobacterium abscessus, with focus on cystic fibrosis. J Clin Microbiol 2007;45:14971504.

229. H Tettelin , RM Davidson , S Agrawal , et al. High-level relatedness among Mycobacterium abscessus subsp. massiliense strains from widely separated outbreaks. Emerg Infect Dis 2014;20:364371.

231. W Chalermskulrat , N Sood , IP Neuringer , et al. Nontuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation. Thorax 2006;61:507513.

232. JB Orens , M Estenne , S Arcasoy , et al. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745755.

233. HC Huang , SS Weigt , A Derhovanessian , et al. Nontuberculous mycobacterium infection after lung transplantation is associated with increased mortality. J Heart Lung Transplant 2011;30:790798.

234. CR Esther Jr, DA Esserman , P Gilligan , A Kerr , PG Noone . Chronic Mycobacterium abscessus infection and lung function decline in cystic fibrosis. J Cyst Fibros 2010;9:117123.

235. F Barbier , A Andremont , M Wolff , L Bouadma . Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med 2013;19:216228.

236. LK Branski , A Al-Mousawi , H Rivero , MG Jeschke , AP Sanford , DN Herndon . Emerging infections in burns. Surg Infect (Larchmt) 2009;10:389397.

237. JN Pendleton , SP Gorman , BF Gilmore . Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther 2013;11:297308.

238. SJ McCallum , MJ Gallagher , JE Corkill , CA Hart , MJ Ledson , MJ Walshaw . Spread of an epidemic Pseudomonas aeruginosa strain from a patient with cystic fibrosis (CF) to non-CF relatives. Thorax 2002;57:559560.

239. ME Dy , JA Nord , VJ LaBombardi , J Germana , P Walker . Lack of throat colonization with Burkholderia cepacia among cystic fibrosis healthcare workers. Infect Control Hosp Epidemiol 1999;20:90.

240. NQ Agochukwu , AR Rastinehad , LA Richter , et al. Prostatic abscess in a pediatric patient with chronic granulomatous disease: report of a unique case and review of the literature. J Pediatr Surg 2012;47:400403.

241. JA Fishman . Infections in immunocompromised hosts and organ transplant recipients: essentials. Liver Transpl 2011;17(suppl 3):S34S37.

242. A Holmes , R Nolan , R Taylor , et al. An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis 1999;179:11971205.

243. FD Lowy . Staphylococcus aureus infections. N Engl J Med 1998;339:520532.

244. HF Chambers . The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis 2001;7:178182.

245. CB Creech 2nd, DS Kernodle , A Alsentzer , C Wilson , KM Edwards . Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatr Infect Dis J 2005;24:617621.

248. JL Nouwen , A Ott , MF Kluytmans-Vandenbergh , et al. Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule.” Clin Infect Dis 2004;39:806811.

249. F Gesualdo , D Bongiorno , C Rizzo , et al. MRSA nasal colonization in children: prevalence meta-analysis, review of risk factors and molecular genetics. Pediatr Infect Dis J 2013;32:479485.

250. WC Albrich , S Harbarth . Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8:289301.

251. G Hawkins , S Stewart , O Blatchford , J Reilly . Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? a review of the evidence. J Hosp Infect 2011;77:285289.

252. PS Grant , LG Charns , BW Rawot , SG Benedetti . Consideration to culture health care workers related to increased methicillin-resistant Staphylococcus aureus activity in a neonatal intensive care unit. Am J Infect Control 2008;36:638643.

253. SA Fritz , J Garbutt , A Elward , W Shannon , GA Storch . Prevalence of and risk factors for community-acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus colonization in children seen in a practice-based research network. Pediatrics 2008;121:10901098.

254. TW Barrett , GJ Moran . Methicillin-resistant Staphylococcus aureus infections among competitive sports participants—Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000–2003. Ann Emerg Med 2004;43:4347.

255. SV Kazakova , JC Hageman , M Matava , et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352:468475.

256. CB Creech , E Saye , BD McKenna , et al. One-year surveillance of methicillin-resistant Staphylococcus aureus nasal colonization and skin and soft tissue infections in collegiate athletes. Arch Pediatr Adolesc Med 2010;164:615620.

257. AR Oller , L Province , B Curless . Staphylococcus aureus recovery from environmental and human locations in 2 collegiate athletic teams. J Athl Train 2010;45:222229.

258. MC Roberts , OO Soge , D No , SE Helgeson , JS Meschke . Characterization of methicillin-resistant Staphylococcus aureus isolated from public surfaces on a university campus, student homes and local community. J Appl Microbiol 2011;110:15311537.

259. EM Begier , K Frenette , NL Barrett , et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39:14461453.

260. DM Nguyen , L Mascola , E Brancoft . Recurring methicillin-resistant Staphylococcus aureus infections in a football team. Emerg Infect Dis 2005;11:526532.

263. JA Rihn , K Posfay-Barbe , CD Harner , et al. Community-acquired methicillin-resistant Staphylococcus aureus outbreak in a local high school football team: unsuccessful interventions. Pediatr Infect Dis J 2005;24:841843.

264. AL Bowers , GR Huffman , BJ Sennett . Methicillin-resistant Staphylococcus aureus infections in collegiate football players. Med Sci Sports Exerc 2008;40:13621367.

265. MP Stevens , G Bearman , A Rosato , M Edmond . Community-acquired methicillin resistant Staphylococcus aureus in a women’s collegiate basketball team. South Med J 2008;101:10671068.

266. A Lear , G McCord , J Peiffer , RR Watkins , A Parikh , S Warrington . Incidence of Staphylococcus aureus nasal colonization and soft tissue infection among high school football players. J Am Board Fam Med 2011;24:429435.

267. JM Lindenmayer , S Schoenfeld , R O’Grady , JK Carney . Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895899.

269. MB de Almeida , RM Zerbinati , AF Tateno , et al. Rhinovirus C and respiratory exacerbations in children with cystic fibrosis. Emerg Infect Dis 2010;16:996999.

270. AR Smyth , RL Smyth , CY Tong , CA Hart , DP Heaf . Effect of respiratory virus infections including rhinovirus on clinical status in cystic fibrosis. Arch Dis Child 1995;73:117120.

271. D Wat , C Gelder , S Hibbitts , et al. The role of respiratory viruses in cystic fibrosis. J Cyst Fibros 2008;7:320328.

272. RA Hoek , MS Paats , SD Pas , et al. Incidence of viral respiratory pathogens causing exacerbations in adult cystic fibrosis patients. Scand J Infect Dis 2013;45:6569.

273. JR Ortiz , KM Neuzil , JC Victor , A Wald , ML Aitken , CH Goss . Influenza-associated cystic fibrosis pulmonary exacerbations. Chest 2010;137:852860.

274. S Asner , V Waters , M Solomon , et al. Role of respiratory viruses in pulmonary exacerbations in children with cystic fibrosis. J Cyst Fibros 2012;11:433439.

275. MA Poritz , AJ Blaschke , CL Byington , et al. FilmArray, an automated nested multiplex PCR system for multi-pathogen detection: development and application to respiratory tract infection. PLoS ONE 2011;6:e26047.

277. Y Maeda , T Stanley , J Stirling , et al. No evidence of transmission of bacteria between reptiles and a CF patient—a case report of a young adult CF patient and reptiles. Zoonoses Public Health 2010;57:e47e53.

278. Z Ner , LA Ross , MV Horn , et al. Bordetella bronchiseptica infection in pediatric lung transplant recipients. Pediatr Transplant 2003;7:413417.

279. S Hemsworth , B Pizer . Pet ownership in immunocompromised children—a review of the literature and survey of existing guidelines. Eur J Oncol Nurs 2006;10:117127.

280. KB Register , N Sukumar , EL Palavecino , BK Rubin , R Deora . Bordetella bronchiseptica in a paediatric cystic fibrosis patient: possible transmission from a household cat. Zoonoses Public Health 2012;59:246250.

281. K Mohan , JL Fothergill , J Storrar , MJ Ledson , C Winstanley , MJ Walshaw . Transmission of Pseudomonas aeruginosa epidemic strain from a patient with cystic fibrosis to a pet cat. Thorax 2008;63:839840.

283. JP Ferreira , VG Fowler Jr, MT Correa , R Lyman , F Ruffin , KL Anderson . Transmission of methicillin-resistant Staphylococcus aureus between human and hamster. J Clin Microbiol 2011;49:16791680.

284. FM Lewis , BJ Marsh , CF von Reyn . Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment, and prevention. Clin Infect Dis 2003;37:390397.

285. TK Pandian , PJ Deziel , CC Otley , AJ Eid , RR Razonable . Mycobacterium marinum infections in transplant recipients: case report and review of the literature. Transpl Infect Dis 2008;10:358363.

287. SL Lefebvre , GC Golab , E Christensen , et al. Guidelines for animal-assisted interventions in health care facilities. Am J Infect Control 2008;36:7885.

288. KA Curran , J Miller . Guidelines for animal-assisted interventions in health care facilities. Am J Infect Control 2009;37:257258.

290. T Sheahan , B Rockx , E Donaldson , et al. Mechanisms of zoonotic severe acute respiratory syndrome coronavirus host range expansion in human airway epithelium. J Virol 2008;82:22742285.

291. JE Moore , CE Goldsmith , BC Millar , et al. Cystic fibrosis and the isolation of Pseudomonas aeruginosa from horses. Vet Rec 2008;163:399400.

292. P Chowdhury , JA Heinemann . The general secretory pathway of Burkholderia gladioli pv. agaricicola BG164R is necessary for cavity disease in white button mushrooms. Appl Environ Microbiol 2006;72:35583565.

293. A Fiore , S Laevens , A Bevivino , et al. Burkholderia cepacia complex: distribution of genomovars among isolates from the maize rhizosphere in Italy. Environ Microbiol 2001;3:137143.

294. SC Miller , JJ LiPuma , JL Parke . Culture-based and non-growth-dependent detection of the Burkholderia cepacia complex in soil environments. Appl Environ Microbiol 2002;68:37503758.

295. A Ramette , JJ LiPuma , JM Tiedje . Species abundance and diversity of Burkholderia cepacia complex in the environment. Appl Environ Microbiol 2005;71:11931201.

296. K Vermis , M Brachkova , P Vandamme , H Nelis . Isolation of Burkholderia cepacia complex genomovars from waters. Syst Appl Microbiol 2003;26:595600.

297. K Muhdi , FP Edenborough , L Gumery , et al. Outcome for patients colonised with Burkholderia cepacia in a Birmingham adult cystic fibrosis clinic and the end of an epidemic. Thorax 1996;51:374377.

298. T Coenye , T Spilker , A Van Schoor , JJ LiPuma , P Vandamme . Recovery of Burkholderia cenocepacia strain PHDC from cystic fibrosis patients in Europe. Thorax 2004;59:952954.

299. MC Fisher , JJ LiPuma , SE Dasen , et al. Source of Pseudomonas cepacia: ribotyping of isolates from patients and from the environment. J Pediatr 1993;123:745747.

300. JJ LiPuma , T Spilker , T Coenye , CF Gonzalez . An epidemic Burkholderia cepacia complex strain identified in soil. Lancet 2002;359:20022003.

301. A Baldwin , E Mahenthiralingam , P Drevinek , et al. Environmental Burkholderia cepacia complex isolates in human infections. Emerg Infect Dis 2007;13:458461.

302. E Mahenthiralingam , A Baldwin , CG Dowson . Burkholderia cepacia complex bacteria: opportunistic pathogens with important natural biology. J Appl Microbiol 2008;104:15391551.

303. D McNeely , JE Moore , JS Elborn , BC Millar , J Rendall , JS Dooley . Isolation of Burkholderia cenocepacia and Burkholderia vietnamiensis from human sewage. Int J Environ Health Res 2009;19:157162.

304. SK Remold , CK Brown , JE Farris , TC Hundley , JA Perpich , ME Purdy . Differential habitat use and niche partitioning by Pseudomonas species in human homes. Microb Ecol 2011;62:505517.

305. T Regnath , M Kreutzberger , S Illing , R Oehme , O Liesenfeld . Prevalence of Pseudomonas aeruginosa in households of patients with cystic fibrosis. Int J Hyg Environ Health 2004;207:585588.

306. P Schelstraete , S Van Daele , K De Boeck , et al. Pseudomonas aeruginosa in the home environment of newly infected cystic fibrosis patients. Eur Respir J 2008;31:822829.

307. J Barben , G Hafen , J Schmid . Pseudomonas aeruginosa in public swimming pools and bathroom water of patients with cystic fibrosis. J Cyst Fibros 2005;4:227231.

308. M Rosenfeld , J Emerson , S McNamara , et al. Risk factors for age at initial Pseudomonas acquisition in the cystic fibrosis epic observational cohort. J Cyst Fibros 2012;11:446453.

310. L Hauben , L Vauterin , ER Moore , B Hoste , J Swings . Genomic diversity of the genus Stenotrophomonas. Int J Syst Bacteriol 1999;49(pt 4):17491760.

311. RC Spencer . The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 1995;30(suppl):453464.

312. SE Kay , RA Clark , KL White , MM Peel . Recurrent Achromobacter piechaudii bacteremia in a patient with hematological malignancy. J Clin Microbiol 2001;39:808810.

313. JO Falkinham 3rd. Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment. J Appl Microbiol 2009;107:356367.

314. MA De Groote , NR Pace , K Fulton , JO Falkinham 3rd. Relationships between Mycobacterium isolates from patients with pulmonary mycobacterial infection and potting soils. Appl Environ Microbiol 2006;72:76027606.

315. K Fujita , Y Ito , T Hirai , et al. Genetic relatedness of Mycobacterium avium-intracellulare complex isolates from patients with pulmonary MAC disease and their residential soils. Clin Microbiol Infect 2013;19:537541.

316. BK Decker , TN Palmore . The role of water in healthcare-associated infections. Curr Opin Infect Dis 2013;26:345351.

317. F Festini , G Taccetti , C Mannini , et al. Patient risk of contact with respiratory pathogens from inanimate surfaces in a cystic fibrosis outpatient clinic: a prospective study over a four-year period. Pediatr Pulmonol 2007;42:779784.

319. DJ Weber , WA Rutala , CN Blanchet , M Jordan , MF Gergen . Faucet aerators: a source of patient colonization with Stenotrophomonas maltophilia. Am J Infect Control 1999;27:5963.

320. M Denton , A Rajgopal , L Mooney , et al. Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis. J Hosp Infect 2003;55:180183.

321. S Valdezate , A Vindel , P Martin-Davila , BS Del Saz , F Baquero , R Canton . High genetic diversity among Stenotrophomonas maltophilia strains despite their originating at a single hospital. J Clin Microbiol 2004;42:693699.

322. CJ Donskey . Does improving surface cleaning and disinfection reduce health care–associated infections? Am J Infect Control 2013;41:S12S19.

323. AD Harris . How important is the environment in the emergence of nosocomial antimicrobial-resistant bacteria? Clin Infect Dis 2008;46:686688.

325. DJ Weber , WA Rutala , MB Miller , K Huslage , E Sickbert-Bennett . Role of hospital surfaces in the transmission of emerging health care–associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38:S25S33.

326. B Hota , DW Blom , EA Lyle , RA Weinstein , MK Hayden . Interventional evaluation of environmental contamination by vancomycin-resistant enterococci: failure of personnel, product, or procedure? J Hosp Infect 2009;71:123131.

328. MB Edmond , RP Wenzel , AW Pasculle . Vancomycin-resistant Staphylococcus aureus: perspectives on measures needed for control. Ann Intern Med 1996;124:329334.

329. DJ Weber , D Anderson , WA Rutala . The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338344.

331. T Blydt-Hansen , K Subbarao , P Quennec , J McDonald . Recovery of respiratory syncytial virus from stethoscopes by conventional viral culture and polymerase chain reaction. Pediatr Infect Dis J 1999;18:164165.

332. JR Kerr , H Martin , MV Chadwick , A Edwards , ME Hodson , DM Geddes . Evidence against transmission of Pseudomonas aeruginosa by hands and stethoscopes in a cystic fibrosis unit. J Hosp Infect 2002;50:324326.

333. LF Muscarella . Prevention of disease transmission during flexible laryngoscopy. Am J Infect Control 2007;35:536544.

335. R Bou , A Aguilar , J Perpinan , et al. Nosocomial outbreak of Pseudomonas aeruginosa infections related to a flexible bronchoscope. J Hosp Infect 2006;64:129135.

337. DL Kirschke , TF Jones , AS Craig , et al. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med 2003;348:214220.