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BCC infection is associated with an accelerated decline in pulmonary function and BMI. Infection with a single B. cenocepacia strain was associated with a more rapid decline in lung function than those infected with either B. multivorans or P. aeruginosa.

Studies of the prevalence of Burkholderia cepacia complex species amongst cystic fibrosis (CF) patients in different geographical regions, and the association between cross-infection and putative transmissibility markers, will further our understanding of these organisms and help to address infection-control issues. In this study, B. cepacia complex isolates from CF patients in different regions of Europe were analysed. Isolates were examined for B. cepacia complex species and putative transmissibility markers [cable pilin subunit gene (cblA) and the B. cepacia epidemic strain marker (BCESM)]. Sporadic and cross-infective strains were identified by random amplification of polymorphic DNA (RAPD). In total, 79 % of patients were infected with Burkholderia cenocepacia (genomovar III), 18 % with Burkholderia multivorans (genomovar II) and less than 5 % of patients with B. cepacia (genomovar I), Burkholderia stabilis (genomovar IV) or Burkholderia vietnamiensis (genomovar V). The cblA and BCESM transmissibility markers were only detected in strains of B. cenocepacia. The BCESM was a more sensitive marker for transmissible B. cenocepacia strains than cblA, although sporadic B. cenocepacia strains containing the BCESM, but lacking cblA, were also observed. Furthermore, clusters of cross-infection with transmissibility marker-negative strains of B. multivorans were identified. In conclusion, B. cenocepacia was the greatest cause of crossinfection, and the most widely distributed B. cepacia complex species, within these CF populations. However, cross-infection was not exclusive to B. cenocepacia and cblA and the BCESM were not absolute markers for transmissible B. cenocepacia, or other B. cepacia complex strains. It is therefore suggested that CF centres cohort patients based on the presence or absence of B. cepacia complex infection and not on the basis of transmissibility marker-positive B. cenocepacia as previously suggested. INTRODUCTIONBurkholderia cepacia has emerged as a life-threatening cause of infection in patients with cystic fibrosis (CF). Strains of B. cepacia can be highly transmissible, resulting in patient-topatient spread within and between CF centres (Govan et al., 1993). To date, the most effective strategy to combat B. cepacia infection has been the strict segregation of infected patients. Although successful, the introduction of such a policy has proved controversial and unpopular with many CF patients. Furthermore, segregation will not prevent sporadic acquisition of B. cepacia complex organisms from natural environments .To complicate the clinical problems associated with B. cepacia infection, polyphasic taxonomic studies have now discovered that B. cepacia is a complex of nine genetically distinct species, all capable of causing CF-related infections . Putative transmissibility markers for B. cepacia complex bacteria have now also been identified. These markers include the cable pilin subunit gene (cblA), which encodes a giant cable-like pilus that facilitates adherence to respiratory mucins (Sajj...