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Superbug passing between people with cystic fibrosis

Trust-funded project reveals the threat posed by cross-infection and antibiotic resistance, and offers hope for identifying new ways to fight back.

A Strategic Research Centre led by the University of Cambridge in collaboration with the Wellcome Trust Sanger Institute, has published new research in the journal ‘Science’ demonstrating for the first time that the multidrug-resistant infection M. abscessus can spread between people with cystic fibrosis.

It was previously thought that people picked up the bug from the environment, and could not pass it on to others. However, by sequencing the whole genome of mycobacteria from individuals attending cystic fibrosis (CF) centres in Europe, the US and Australia, the team has revealed that the majority were transmissible forms of M. abscessus, which evidence suggests may be transmitted within hospitals via contaminated surfaces and through the air.

The superbug, a type of non-tuberculous mycobacterium, is hard to treat and is particularly harmful to people with CF and other lung conditions, causing a pneumonia that can lead to increased lung damage, and may prevent safe lung transplantation.

Professor Andres Floto (pictured) from the Department of Medicine, University of Cambridge, and the Cambridge Centre for Lung Infection at Papworth Hospital NHS Foundation Trust, said: “The bug initially seems to have entered the patient population from the environment, but we think it has recently evolved to become capable of jumping from patient to patient, getting more virulent as it does so.”

Research brings hope for the future

The team’s findings have already helped shape the design of the new CF unit due to open when the New Papworth Hospital opens in Cambridge in 2018, with an innovative new air-handling system.

The sequencing data has also revealed potential new drug targets, and the team is now focussed on working with other groups at the University of Cambridge and Colorado State University to develop these further.

Professor Julian Parkhill from the Wellcome Trust Sanger Institute at Hinxton, Cambridgeshire, adds: “Our research should provide a degree of hope: now that we know the extent of the problem and are beginning to understand how the infection spreads, we can start to respond. Our work has already helped inform infection control policies and provides the means to monitor the effectiveness of these.”

The researchers will also look to identify how the bug is spreading across continents, with one theory being that healthy individuals may be unwittingly carrying the mycobacteria between countries.

Dr Janet Allen, Director of Strategic Innovation at the Trust, said: “This paper highlights the risks posed through transmission of multi-drug resistant organisms between people with cystic fibrosis. The Trust led the way in this important area by publishing interim cross-infection guidelines specifically for M. abscessus, which this paper will now help us to develop and improve alongside the CF community.

“This work also demonstrates how vital the support of the CF community is in funding life-changing research. This study exemplifies the enormous impact of Trust-funded Strategic Research Centres, which were designed to generate world-class research with the very highest impact. Without the support of the CF community, this landmark study would not have been possible.”

Dr Keith Brownlee, Director of Impact at the Trust, said, "The Trust is supporting research into M. abscessus and is contributing funding towards the development of a National Nontuberculous Mycobacteria whole genome sequencing service, which will enable all CF centres in the UK to look for evidence of cross-infection between people with cystic fibrosis. Data from the 2015 UK Cystic Fibrosis Registry report shows that in 2014, 6.2% of people with cystic fibrosis were infected with non-tuberculous mycobacteria; in 2015, this had dropped to 5.6%. The number of new instances of M. abscessus has been falling steadily from 1.8% in 2012 to 0.7% in 2015 and we hope this research will help that trend to continue.

"The Trust will continue to work with academics and the clinical community to updgrade cross-infection guidelines as appropriate and continue to monitor the number of new cases of infection with M. abscessus and other infections.”

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