29 March 2013

Rise in CF patient infections explained

DNA sequencing reveals evidence for Mycobacterium abscessus transmission between Cystic Fibrosis patients

Network analysis of patients with clustered and non-clustered M. abscessus.

Network analysis of patients with clustered and non-clustered M. abscessus. [doi: 10.1016/S0140-6736(13)60632-7]

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Researchers at Papworth Hospital, the University of Cambridge and the Wellcome Trust Sanger Institute have discovered why a new type of dangerous bacterial infection has become more common among people with Cystic Fibrosis around the world. Through their ground-breaking research, the team has developed new measures to protect Cystic Fibrosis patients.

People with Cystic Fibrosis are prone to serious infection in part because they have sticky mucus that can clog up their lungs. In recent years doctors have seen a global increase in the number of infections caused by the antibiotic-resistant bacterial species Mycobacterium abscessus (M. abscessus). M. abscessus is distantly related to the bacterium that causes Tuberculosis and is usually found in water and soil. Until now, experts had thought it could not be passed from person to person.

"There has been worldwide concern about the rising number of M. abscessus infections in people with Cystic Fibrosis and anxiety that spread from person to person might be responsible," said Dr Andres Floto, Research Director of the Cystic Fibrosis Unit at Papworth Hospital, Principal Investigator at the Cambridge Institute for Medical Research, University of Cambridge and lead author of the research published in The Lancet. "Our work has allowed us to lead the world in changing hospital infection control: we used state-of-the-art DNA sequencing technology to understand how the infection is being spread, which conventional techniques would have missed."

"Our results will help to protect patients from this serious infection."

" We are increasingly able to use DNA studies to improve patient care. "

Professor Julian Parkhill

The team used the latest methods to sequence the genomes of almost 170 isolates of M. abscessus from Cystic Fibrosis patients collected over a five-year period. By looking at the fine detail of the relationships between the bacterial genomes, to produce a 'family tree', the research team could determine where it was likely that infection had passed from one patient to another. They showed that, even with nationally recommended infection control measures in place, M. abscessus can spread between patients.

"Whole genome sequencing gives the highest resolution when determining the similarities and relatedness of each M. abscessus strain, unravelling the origin of the infection in patients," says Josie Bryant, joint first author from the Wellcome Trust Sanger Institute. We've used this method to uncover probable transmission events, having important consequences for infection control."

"We are increasingly able to use DNA studies to improve patient care," says Professor Julian Parkhill, Head of Pathogen Genomics at the Wellcome Trust Sanger Institute. "By sequencing the complete genomes of bacteria we can accurately describe where they have emerged from and how they pass from person to person.

"This knowledge means that the clinical teams can develop new health measures to safeguard their patients. Our aim is to develop the best methods to detect and control infection."

This new information has led to rapid changes in how people with Cystic Fibrosis are cared for in hospital to protect them from this emerging threat.

Notes to Editors

Publication details

  • Whole-genome sequencing to identify transmission of Mycobacterium abscessus between patients with cystic fibrosis: a retrospective cohort study.

    Bryant JM, Grogono DM, Greaves D, Foweraker J, Roddick I, Inns T, Reacher M, Haworth CS, Curran MD, Harris SR, Peacock SJ, Parkhill J and Floto RA

    Lancet 2013;381;9877;1551-60

Funding

This work was supported by The Wellcome Trust, Papworth Hospital, NIHR Cambridge Biomedical Research Centre, The UK Health Protection Agency, Medical Research Council, and the UKCRC Translational Infection Research Initiative.

Participating Centres

  • Wellcome Trust Sanger Institute, Hinxton, UK
  • Cambridge Institute for Medical Research, University of Cambridge, UK
  • Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
  • Department of Medicine, University of Cambridge, UK
  • Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK
  • HPA Health Protection Agency East of England Regional Epidemiology Unit, UK
  • HPA, Norfolk, Suffolk & Cambridgeshire Health Protection Unit, UK
  • Field Epidemiology Training Programme (FETP), Health Protection Agency, London, UK

University of Cambridge

The mission of the University of Cambridge is to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. It admits the very best and brightest students, regardless of background, and offers one of the UK's most generous bursary schemes. The University of Cambridge's reputation for excellence is known internationally and reflects the scholastic achievements of its academics and students, as well as the world-class original research carried out by its staff. Some of the most significant scientific breakthroughs occurred at the University, including the splitting of the atom, invention of the jet engine and the discoveries of stem cells, plate tectonics, pulsars and the structure of DNA. From Isaac Newton to Stephen Hawking, the University has nurtured some of history's greatest minds and has produced more Nobel Prize winners than any other UK institution with over 80 laureates.

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Papworth Hospital

Papworth Hospital is an international centre of excellence for the treatment of heart and lung disease. Since carrying out the UK's first successful heart transplant in 1979, Papworth has established a reputation for leading edge research and innovation in cardiopulmonary medicine and surgery. As part of the Cambridge Centre for Lung Infection (CCLI), the Adult Cystic Fibrosis Centre at Papworth Hospital was established in 1994 and now looks after over 280 adults with CF from throughout the Eastern Region. The service is supported by a multidisciplinary team including: four CF specialist consultants, three CF specialist nurses, a dedicated team of ward nurses, research nurses, specialist physiotherapists, dieticians, pharmacists, social workers, psychologist, psychiatrist, secretaries and managers. Research within the CCLI has focused on understanding how bacteria, particularly nontuberculous mycobacteria (NTM) cause infection and inflammatory lung damage.

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The Wellcome Trust Sanger Institute

The Wellcome Trust Sanger Institute is one of the world's leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease.

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The Wellcome Trust

The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. We support the brightest minds in biomedical research and the medical humanities. Our breadth of support includes public engagement, education and the application of research to improve health. We are independent of both political and commercial interests.

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