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Patients with CF segregated because of Burkholderia cepacia infection must be helped to assemble coherent structures for social relationships if they are to adapt successfully to such management.
In 1997 the median life expectancy for individuals with cystic fibrosis (CF) was 31.5 years in the UK1 and it has been suggested that those born today can expect to live well into their mid 40s.2 However, there is huge variability in the physical condition of adults with CF. While malabsorption, osteoporosis, diabetes, and liver failure all contribute to incapacity, lung disease is the main cause of morbidity and mortality. Some patients have near normal levels of lung function. Others, however, are debilitated by dyspnoea and dependent on oxygen.
Lung disease in CF is primarily due to the consequences of infection. In the first decade of life Staphylococcus aureus and Haemophilus influenzae are the predominant organisms in sputum, while in older children and adults Pseudomonas aeruginosa is most common.3 In the past 15 years some CF centres have had epidemics of Burkholderia cepacia infection. Although patients respond to standard antibiotic treatment,4 most become chronically infected and experience a more rapid decline in lung function. The reasons for this are still unclear, although recent microbiological findings suggest that there are different pathogenic potentials of various B cepacia genomovars.5 In the UK prevalence rates vary between centres but increase significantly if spread from patient to patient is not prevented. In this respect, B cepacia differs from other bacteria in that it is usually caught through close or frequent contact with another B cepacia positive CF patient.5,6
In most UK adult CF centres it is now accepted practice to separate patients who are infected with B cepacia from those who are not. Guidelines on cross infection effectively mean …