Article Text

other Versions

PDF
Treatment decisions for MRSA in patients with cystic fibrosis (CF): when is enough, enough?
  1. Scott C Bell1,2,
  2. Patrick A Flume3
  1. 1QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
  2. 2Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
  3. 3Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Scott C Bell, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia; scott.bell{at}health.qld.gov.au

Statistics from Altmetric.com

Treatment of infection in cystic fibrosis (CF) lung disease should be based on identifying which organisms warrant treatment, requiring evidence that the pathogen leads to worse outcomes and that intervention yields better clinical outcomes. This has been demonstrated for Pseudomonas aeruginosa, where eradication of early infection and suppression of chronic infection have become the standard of care. This approach has not been broadly adopted for Staphylococcus aureus, in part because of insufficient evidence demonstrating an association with worse outcomes and treatment has not proven better outcomes. However, there is a rising concern about methicillin-resistant S. aureus (MRSA). MRSA infection in patients with CF has been associated with more severe pulmonary disease and poorer clinical outcomes.1–3

Rates of MRSA infection have increased dramatically and now exceed 25% of the CF population in the USA, paralleling rates in the general community.4 Notably, prevalence rates of MRSA are significantly lower in other countries including the UK and Australia (each 2.6%).5 ,6 Given these observations, efforts to treat MRSA would seem relevant, but evidence of treatment benefit is lacking. Until now, treatment approaches for MRSA have been anecdotal and decision-making has been supported by small studies.7–15

The results of a prospective, open-label randomised study of the treatment of early MRSA infection in patients with CF are reported.16 The primary endpoint was a microbiological one—could they render the patient culture negative, often assumed to represent eradication? Participants were randomly allocated to treatment or a period of observation. Treatment included antibiotics for 14 days in addition to hygienic measures aimed to reduce nasal, cutaneous and domestic environmental colonisation. The key findings of the study were a higher proportion of patients without MRSA in airway cultures at 28 days (82%—treatment arm vs 26%—observation arm).

Two important trial conduct issues were identified …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Cystic fibrosis
    Marianne Sponer Muhlebach Valeria Beckett Elena Popowitch Melissa B Miller Arthur Baines Nicole Mayer-Hamblett Edith T Zemanick Wynton C Hoover Jill M VanDalfsen Preston Campbell Christopher H Goss STAR-too study team STAR-too study team Debbie Ng John McNamara Mahrya Johnson Silby Moonnumakal Nicoline Schaap Meg Anthony John P Clancy Ronald Gibson Sharon McNamara Peter Michelson Tina Hicks Preeti Sharma Andrew Hebert Katie Brand Pamela Schuler Dawn Baker Amy Filbrun Marisa Linn Paul Sammut Raquel Telfer Kelly Moormann Karen Schultz Heather Urbanek Margaret Guill John J LiPuma Marci Sontag Susan Murray Miriam Hunt Dianne L. Howe Jasna Hocevar-Trnka Rose Mitchell Lynette Browne