ABSTRACT
Outbreaks of infection with epidemic strains of Burkholderia cenocepacia were rst identied at CF centers in the late 1980s and early 1990s.2 Several strains of B. cenocepacia were associated with large cross-infection outbreaks and one strain, known as “B. cenocepacia strain ET-12,” spread among patients in several countries.3,4 e infected patients suered from an increased morbidity
and reduced survival.5 In many countries, they were also excluded from lung transplantation programs due to an association with poor post-transplant outcomes.6,7 Strict cohort segregation policies were introduced at CF centers to contain spread.1 ese measures were also applied to social gatherings and meetings. is had profound eects on the support and functioning of the CF community, with infected patients banned from group activity and educational events. Although two DNA “markers” (“Burkholderia cepacia epidemic strain marker” and “cable pilus”) were initially identied to be associated with epidemic B. cenocepacia strains, it was later shown that these were not accurate indicators of transmissibility.8 Subsequently it was recognized that some B. cenocepacia strains could replace other BCC, sometimes referred to as “superinfection.”9 is too was oen associated with a marked clinical deterioration of the patients and therefore the initial cohort segregation policies were further extended to isolate patients individually or segregate by strain of organism.
