Criteria for colonization:
(1) >= 3 positive sputums over at least 1 month
(2) 1 positive culture
Criteria for eradication vary and involve:
(1) >= 5 negative consecutive sputum cultures over at least 3 months
(2) >= 3 negative consecutive sputum cultures over at least 12 months (1 year)
A patient who has cleared the organism needs to be monitored periodically for recolonization.
Management issues:
(1) The patient needs to be informed of the colonization and educated as to its significance.
(2) Until eradication has been confirmed the patient must be segregated from other patients with cystic fibrosis. This includes other patients who have been colonized since they may exchange different strains in the complex.
(3) The antibiotic susceptibility pattern of the isolate needs to be determined. It may be decided to wait to see if the patient clears the organism spontaneously. Antibiotic therapy to eradicate the organism should be based on considering the pros and cons of therapy but guided by the susceptibility pattern.
(4) The patient's environment needs to be carefully cleaned to remove other residual foci of the organism. Perform periodic survey cultures to detect environmental sources.
(5) The patient needs to be trained in handwashing technique and barrier precautions to prevent spread of the isolate.
