In this study, the suitability of two repetitive-element-based PCR (rep-PCR) assays, enterobacterial repetitive intergenic consensus (ERIC)-PCR and BOX-PCR, to rapidly characterize Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis (CF) was examined. ERIC-PCR utilizes paired sequence-specific primers and BOX-PCR a single primer that target highly conserved repetitive elements in the P. aeruginosa genome. Using these rep-PCR assays, 163 P. aeruginosa isolates cultured from sputa collected from 50 patients attending an adult CF clinic and 50 children attending a paediatric CF clinic were typed. The results of the rep-PCR assays were compared to the results of PFGE. All three assays revealed the presence of six major clonal groups shared by multiple patients attending either of the CF clinics, with the dominant clonal group infecting 38 % of all patients. This dominant clonal group was not related to the dominant clonal group detected in Sydney or Melbourne (pulsotype 1), nor was it related to the dominant groups detected in the UK. In all, PFGE and rep-PCR identified 58 distinct clonal groups, with only three of these shared between the two clinics. The results of this study showed that both ERIC-PCR and BOX-PCR are rapid, highly discriminatory and reproducible assays that proved to be powerful surveillance screening tools for the typing of clinical P. aeruginosa isolates recovered from patients with CF.
INTRODUCTIONPseudomonas aeruginosa is a major cause of chronic lung infection in children and adults with cystic fibrosis (CF) and results in significant morbidity and mortality (Hutchison & Govan, 1999). Epidemic, multi-resistant strains have been reported within CF clinics in Australia and the UK (Anthony et al., 2002;Armstrong et al., 2002;Jones et al., 2001; McCallum et al., 2001McCallum et al., , 2002. Strain typing by traditional phenotypic methods is an important part of epidemiological surveillance, but may lack discriminatory power and stability. Molecular techniques offer a considerable improvement, and can complement phenotypic data to obtain a better understanding of bacterial diversity (Olive, 1999).PFGE is commonly employed, and has achieved widespread recognition as the 'gold standard' for P. aeruginosa DNA typing (Bertrand et al., 2001;Breitenstein et al., 1997;Douglas et al., 2001;Grundmann et al., 1995;Spencker et al., 2000). However, this method is limited by technical complexity, expense and prolonged turnaround times for results (Olive, 1999 (Versalovic et al., 1991). Two such groups of repetitive elements are the enterobacterial repetitive intergenic consensus (ERIC) sequences common to Gram-negative enteric bacteria, and the BOX elements, originally detected in Streptococcus pneumoniae (Hulton et al., 1991;Martin et al., 1992;Tyler et al., 1997).To our knowledge, ERIC-and BOX-PCR have not previously been used to compare P. aeruginosa strains isolated from adult and paediatric patients with CF. In this study, we characterized 163 clinical isolates collected from 50 ch...