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

H Hall; R Gadhok; K Alshafi; D Bilton; N J Simmonds

doi:10.1016/j.rmed.2015.01.013

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

Respir Med. 2015 Mar;109(3):357-63. doi: 10.1016/j.rmed.2015.01.013. Epub 2015 Feb 3.

Authors

H Hall¹, R Gadhok¹, K Alshafi², D Bilton³, N J Simmonds⁴

Affiliations

¹ Adult Cystic Fibrosis Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
² Dept of Microbiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
³ Adult Cystic Fibrosis Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK.
⁴ Adult Cystic Fibrosis Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK. Electronic address: n.simmonds@imperial.ac.uk.

PMID: 25683032
DOI: 10.1016/j.rmed.2015.01.013

Abstract

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.

Keywords: Cystic fibrosis; Eradication; Infection; MRSA; Methicillin resistant Staphylococcus aureus.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anti-Bacterial Agents / therapeutic use*
Body Mass Index
Cystic Fibrosis / complications*
Disease Eradication
Drug Therapy, Combination
Female
Fusidic Acid / therapeutic use*
Humans
Male
Methicillin-Resistant Staphylococcus aureus / drug effects
Methicillin-Resistant Staphylococcus aureus / isolation & purification*
Middle Aged
Outpatient Clinics, Hospital*
Pneumonia, Staphylococcal / drug therapy
Pneumonia, Staphylococcal / microbiology
Prevalence
Respiratory Tract Infections / drug therapy*
Respiratory Tract Infections / epidemiology
Respiratory Tract Infections / microbiology*
Respiratory Tract Infections / prevention & control
Retrospective Studies
Rifampin / therapeutic use*
Treatment Outcome
United Kingdom / epidemiology

Substances

Anti-Bacterial Agents
Fusidic Acid
Rifampin