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Cystic fibrosis pathogens survive for extended periods within cough-generated droplet nuclei
  1. Michelle E Wood1,2,3,
  2. Rebecca E Stockwell1,3,
  3. Graham R Johnson4,
  4. Kay A Ramsay1,3,
  5. Laura J Sherrard1,5,
  6. Timothy J Kidd1,6,7,
  7. Joyce Cheney8,
  8. Emma L Ballard9,
  9. Peter O’Rourke9,
  10. Nassib Jabbour4,
  11. Claire E Wainwright3,7,8,
  12. Luke D Knibbs10,
  13. Peter D Sly3,7,
  14. Lidia Morawska4,
  15. Scott C Bell1,2,3
  1. 1Lung Bacteria Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  2. 2Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
  3. 3Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  4. 4International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
  5. 5School of Pharmacy, Queen’s University Belfast, Belfast, United Kingdom
  6. 6School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
  7. 7Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
  8. 8Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, Queensland, Australia
  9. 9Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  10. 10School of Public Health, The University of Queensland, Herston, Queensland, Australia
  1. Correspondence to Ms Michelle E Wood, Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; michelle.wood2{at}health.qld.gov.au

Abstract

The airborne route is a potential pathway in the person-to-person transmission of bacterial strains among cystic fibrosis (CF) populations. In this cross-sectional study, we investigate the physical properties and survival of common non-Pseudomonas aeruginosa CF pathogens generated during coughing. We conclude that Gram-negative bacteria and Staphylococcus aureus are aerosolised during coughing, can travel up to 4 m and remain viable within droplet nuclei for up to 45 min. These results suggest that airborne person-to-person transmission is plausible for the CF pathogens we measured.

  • cystic fibrosis
  • infection control

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Footnotes

  • Contributors GRJ, TJK, CEW, LDK, PDS, LM and SCB led the funding application and conceived the study design. MEW, JC and SCB contributed to subject recruitment. MEW, RES, GRJ and NJ conducted the studies and collected the participant data and samples. RES, KAR and LJS performed the microbiological analysis. TJK and KAR undertook the genotypic analyses for GNB and Pathology Queensland for Staphylococcus aureus. ELB and POR led the statistical analysis. MEW and SCB oversaw the overall study and wrote the manuscript, with input from all authors.

  • Funding The project was funded from grants from Cystic Fibrosis Foundation Therapeutics, USA (BELL14AO) and The Prince Charles Hospital Foundation (MS2014-20).

  • Competing interests During conduct of the study: SCB reports grants from Cystic Fibrosis Foundation Therapeutics, USA, and The Prince Charles Hospital Foundation and outside of the submitted work, travel support to attend conferences from Novartis and Gilead and meetings for clinical trials sponsored by Vertex, Abbvie, Raptor. LDK reports grants from the NHMRC during the conduct of the study. GRJ reports grants from Cystic Fibrosis Foundation Therapeutics, USA, and The Prince Charles Hospital Foundation during the conduct of the study. CEW reports outside of the submitted work: research grant from Novo Nordisk Pharmaceuticals; honorarium fees as speaker for Vertex, DKBmed; honorarium for consulting work (BMJ, Vertex), advisory board (Vertex); to present at conference (Novartis), attendance at meetings (University of Miami), Associate Editor duties (Thorax) and travel support to attend meetings for clinical trials sponsored by Vertex. CEW is Associate Editor Thorax and Associate Editor Respirology. MEW reports outside of submitted work: travel support to attend clinical trial meetings sponsored by Vertex and Galapagos.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The project was granted approval by the Children’s Queensland Human Research Ethics Committee HREC/14/RCH/88 and The Prince Charles Hospital Research Governance Office SSA/14/TPCH/202. Participants provided written consent/assent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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