Eradication of respiratory tract MRSA at a large adult cystic fibrosis centre

• Published in: Respiratory medicine Vol. 109; no. 3; pp. 357 - 363
• Main Authors: Hall, H, Gadhok, R, Alshafi, K, Bilton, D, Simmonds, N.J
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2015; Elsevier Limited
• Subjects: Acids; Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biomedical research; Body Mass Index; Cystic fibrosis; Cystic Fibrosis - complications; Disease Eradication; Drug therapy; Drug Therapy, Combination; Eradication; Female; Fusidic Acid - therapeutic use; Humans; Infection; Male; Methicillin resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Mortality; MRSA; Outpatient Clinics, Hospital; Patients; Pneumonia, Staphylococcal - drug therapy; Pneumonia, Staphylococcal - microbiology; Prevalence; Pulmonary/Respiratory; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Respiratory Tract Infections - prevention & control; Retrospective Studies; Rifampin - therapeutic use; Staphylococcus infections; Studies; Treatment Outcome; United Kingdom - epidemiology; Infection; Cystic fibrosis; Methicillin resistant Staphylococcus aureus; Eradication; MRSA
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2015.01.013

Summary Introduction The prevalence of MRSA in patients with CF is increasing. There is no consensus as to the optimum treatment. Method An observational cohort study of all patients with MRSA positive sputum, 2007–2012. All eradication attempts with subsequent culture results were reviewed. Single vs dual antibiotic regimens were compared for both new and chronic infections. Results 37 patients (median FEV1 58.7 (27.6–111.5)% predicted) were identified, of which 67.6% ( n  = 25) had newly acquired MRSA. Compared with single regimens, a high proportion of dual regimens achieved MRSA eradication (84.6% vs 50%; p  = 0.1) for new infections. Rifampicin/Fusidic acid was associated with high success rates (100% vs 60% for other dual regimens ( p  = 0.13)). Compared with new infections, chronic MRSA was much less likely to be eradicated (18.2%, p  = 0.01). Conclusion Combined antibiotic therapy, particularly Rifampicin/Fusidic acid, is a well-tolerated and effective means of eradicating MRSA in patients with cystic fibrosis.