MRSA and CF survival

JAMA. 2010 Jun 16;303(23):2386-92.

Association between respiratory tract methicillin-resistant Staphylococcus aureus and survival in cystic fibrosis.

Dasenbrook EC, Checkley W, Merlo CA, Konstan MW, Lechtzin N, Boyle MP.

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio 44106-5067, USA. ecd28@case.edu

Abstract

CONTEXT: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the respiratory tract of individuals with cystic fibrosis (CF) has increased dramatically; however, its impact on outcomes in CF is unclear. Because the time between infection with bacteria in CF and death can be decades, observational studies with long periods of follow-up are well suited to address the current gap in knowledge.

OBJECTIVE: To determine whether isolation of MRSA from the respiratory tract of CF patients is associated with worse survival compared with patients who never have a culture positive for MRSA.

DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 19,833 CF patients aged 6 to 45 years seen at centers accredited by the Cystic Fibrosis Foundation in the United States. Patients entered between January 1996 and December 2006 and were followed up through December 2008. Cox regression models with time-varying covariates were used to compare survival between CF patients with and without respiratory tract MRSA. MAIN OUTCOME MEASURE: Time from age at entry until age at death from any cause.

RESULTS: In 137,819 patient-years of observation (median, 7.3 years/patient), 2537 CF patients died and 5759 patients had MRSA detected. The mortality rate was 18.3 deaths (95% confidence interval [CI], 17.5-19.1) per 1000 patient-years in patients without MRSA and 27.7 deaths (95% CI, 25.3-30.4) per 1000 patient-years in those with MRSA. Among those with MRSA, the attributable risk percentage of death associated with MRSA was 34.0% (95% CI, 26.7%-40.4%). The unadjusted hazard ratio associated with MRSA was 1.47 (95% CI, 1.32-1.62). After adjustment for time-varying covariates associated with severity of illness, MRSA remained associated with a higher risk of death (1.27; 95% CI, 1.11-1.45).

CONCLUSION: Detection of MRSA in the respiratory tract of CF patients was associated with worse survival.

New Study in JAMA Examines Impact of MRSA on Cystic Fibrosis

New Study in JAMA Examines Impact of MRSA on Cystic Fibrosis

June 16, 2010

A study published today in the Journal of the American Medical Association examines the effect that methicillin-resistant Staphylococcus aureus (MRSA) has on people with cystic fibrosis. It found that chronic infection with MRSA in people with CF was associated with worse survival than those who don’t have the bacteria.

MRSA can cause infections that are resistant to some common antibiotics. More than 20 percent of people with CF have MRSA in their respiratory tract.

Of the various bacteria that cause lung infections in CF, Burkholderia cepacia complex has been most commonly associated with shortened life span. This study is the first to find a possible link between MRSA and survival rates.

The Foundation is currently funding a study to find the most effective way to treat MRSA infections in CF patients. This will lead to clinical trials to test treatments in CF patients with chronic MRSA infection and those with newly acquired MRSA.

The CF Foundation has stringent infection control standards, which were developed in partnership with CF physicians and infection control experts.

The best protection against getting MRSA and other germs is to:

• Clean your hands often, use soap and water or alcohol-based hand gel;
• Cough into a tissue, throw it away and then clean your hands;
• Clean and disinfect nebulizers regularly;
• Avoid people who are sick; and
• Do not share utensils or cups.

The Foundation encourages people with CF to work closely with a cystic fibrosis physician at an accredited CF Foundation care center to address infection and treatment-related issues.

http://www.cff.org/aboutCFFoundation/NewsEvents/06-16-JAMA-Study-Examines-Impact-of-MRSA-on-CF.cfm

Patient segregation and aggressive antibiotic eradication therapy can control methicillin-resistant Staphylococcus aureus at large cystic fibrosis cen

J Cyst Fibros. 2010 Mar;9(2):104-9. Epub 2010 Jan 3.

Patient segregation and aggressive antibiotic eradication therapy can control methicillin-resistant Staphylococcus aureus at large cystic fibrosis centres.

Doe SJ, McSorley A, Isalska B, Kearns AM, Bright-Thomas R, Brennan AL, Webb AK, Jones AM.
Manchester Adult CF Centre, University Hospitals of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK. simondoe@doctors.org.uk

BACKGROUND: The prevalence of MRSA in patients with CF has risen in recent years. We adhere to a policy of segregation and barrier nursing to manage patients with MRSA, and we actively pursue eradication of MRSA. We have evaluated our experiences of MRSA infection in our large adult CF centre.

METHOD: A retrospective review of all MRSA-positive patients from 1998 to 2008 was undertaken. Isolates were subjected to molecular identification to elucidate possible patient-to-patient transmission events. Eradication attempts were scrutinised.

RESULTS: We have maintained a low incidence and prevalence (below 3%) of MRSA within this large cohort. A total of 15 pulsotypes of MRSA were identified among the 24 isolates examined, epidemiological data suggested no patient-patient transmission. Based on 6 month follow-up data, successful eradication was achieved in 81% patients. This includes those who had harboured infection for some time. Twenty-one (80.8%) required only one course of treatment, 3 (11.6%) patients required two different regimes and 2 (7.5%) required three courses to fully eradicate the organism.

CONCLUSION: Strict infection control procedures can control MRSA infection and keep the prevalence low in CF clinics. Eradication is achievable in the majority of patients even when significant time has lapsed from initial isolation. In some instances, up to 3 courses of antibiotics were required to achieve eradication.

Persistent methicillin-resistant Staphylococcus aureus and rate of FEV1 decline in cystic fibrosis

http://snipurl.com/fli4s