The impact of methicillin-resistant Staphylococcus aureus colonisation on paediatric cystic fibrosis patients’ morbidity

Fermeiro, Joana; Reis, Patrícia; Castanhinha, Susana; Pereira, Luísa; Barreto, Celeste; Gomes-Pedro, Doutor João

doi:10.1016/S2173-5115(10)70057-9

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Abstract

Background

Methicillin-resistant Staphylococcus aureus (MRSA) plays a well-recognised pathogenic role in cystic fibrosis (CF).

Aims

To evaluate the prevalence and incidence of colonisation by MRSA, clinical impact of MRSA colonisation (year after first MRSA isolation), risk factors and pattern of antimicrobial resistance.

Methods

Retrospective review of paediatric CF patients colonised with MRSA followed-up at the CF Unit of Hospital de Santa Maria 2003–2007.

Results

Twelve of the 60 patients followed-up during this period were MRSA-positive at some time (chronic colonisation in 3 patients). Mean age at acquisition was 9 years 10 months and mean time interval between CF diagnosis and MRSA acquisition 5 years 7 months.

An important rise in MRSA colonisation prevalence and incidence was observed, with the highest rate seen in 2007 (prevalence 14.3% and incidence 8.9%).

Four patients had received anti-staphylococcal prophylaxis with flucloxacillin.

An increase in the total number of in-patient days was observed in four patients (two with chronic colonisation). Deterioration in lung function was seen in five patients (including the three patients with chronic colonisation). Only one patient had a decrease in body mass index percentile.

Resistance to clindamycin and rifampin was the most frequently seen.

Conclusions

This study revealed significant clinical deterioration in patients with chronic colonisation by MRSA, reinforcing the importance of effective and timely decolonisation strategies.

Key-words:

Cystic fibrosis

MRSA

decolonisation

Resumo

Introdução

Ao Staphylococcus aureus resistente à meticilina (MRSA) é classicamente reconhecido um papel patogénico no âmbito da fibrose quística (FQ).

Objectivos

Avaliação da evolução da prevalência e incidência da colonização por MRSA, impacto clínico no ano após o primeiro isolamento, factores de risco e padrão de resistência antimicrobiana.

Métodos

Estudo retrospectivo dos doentes pediátricos colonizados por MRSA seguidos no centro de FQ do Hospital de Santa Maria de 2003 a 2007.

Resultados

O MRSA foi isolado em secreções respiratórias de 12 dos 60 doentes seguidos durante este período (colonização crónica em 3 doentes). A idade média à data do primeiro isolamento foi de 9 anos e 10 meses e o tempo médio entre o diagnóstico de FQ e a aquisição de MRSA de 5 anos e 7 meses.

Verificou-se um aumento da prevalência e incidência de colonização por MRSA, com um máximo atingido em 2007 (prevalência 14,3% e incidência 8,9%). Quatro doentes cumpriram antibioticoterapia profiláctica antiestafilocócica com flucloxacilina.

No ano após o primeiro isolamento de MRSA, constatou-se um aumento do número de dias de internamento em 4 doentes (2 com colonização crónica) e deterioração da função pulmonar em 5, incluindo a totalidade dos doentes com colonização crónica. Apenas um doente apresentou diminuição de percentil de índice de massa corporal.

As resistências mais frequentemente encontradas foram à rifampicina e à clindamicina.

Conclusões

Este estudo revelou ocorrência de deterioração clínica relevante em doentes com colonização crónica por MRSA, reforçando a importância da implementação de estratégias eficazes e precoces de erradicação.

Palavras-chave:

Fibrose quística

MRSA

erradicação

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Bibliography/Bibliografia

[1.]

S.P. Conway, K.G. Brownlee, M. Denton, D.G. Peckham.

Antibiotic treatment of multidrug-resistant organisms in cystic fibrosis.

Am J Respir Med, 2 (2003), pp. 321-332

Medline

[2.]

M. Macfarlane, A. Leavy, J. McCaughan, R. Fair, A.J.M. Reid.

Successful decolonization of meticillin-resistant Staphylococcus aureus in paediatric patients with cystic fibrosis (CF) using a three-step protocol.

J Hosp Infect, 65 (2007), pp. 231-236

http://dx.doi.org/10.1016/j.jhin.2006.10.011 | Medline

[3.]

G. Valenza, D. Tappe, D. Turnwald, M. Frosch, C. König, et al.

Prevalence and antimicrobial susceptibility of microorganisms isolated from sputa of patients with cystic fibrosis.

J Cyst Fibros, 7 (2008), pp. 123-127

http://dx.doi.org/10.1016/j.jcf.2007.06.006 | Medline

[4.]

S. Razvi, L. Quittell, A. Sewall, H. Quinton, B. Marshall, et al.

Respiratory microbiology of patients with cystic fibrosis in the United States, 1995–2005.

Chest, (2009),

Medline

[5.]

M.P. Jevons.

Celbenin-resistant staphylococci.

BMJ, 1 (1961), pp. 124-125

Medline

[6.]

W.B. Grubb.

Genetics of MRSA.

Rev Med Microbiol, 9 (1998), pp. 153-162

[7.]

L. Saiman, J. Siegel.

Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens and infection control practices to prevent patient-to-patient transmission.

Infect Control Hosp Epidemiol, 24 (2003), pp. S6-S52

http://dx.doi.org/10.1086/503485 | Medline

[8.]

Cystic Fibrosis Foundation.

Patient registry.

Cystic Fibrosis Foundation, (1995),

[9.]

Cystic Fibrosis Foundation.

Patient registry.

Cystic Fibrosis Foundation, (2001),

[10.]

Cystic Fibrosis Foundation.

Patient registry.

Cystic Fibrosis Foundation, (2005),

[11.]

K. Semczuk, H. Dmenska, D. Dzierzanowska, M. Kolodziejczyk, E. Gabinska, et al.

The analysis of the isolated microorganisms from the respiratory tract of cystic fibrosis patients treated in Children¿s Memorial Health Institute 1999–2002.

Pneumonol Alergol Pol, 73 (2005), pp. 41-47

Medline

[12.]

A.D. Garcia, A. Ibarra, F.C. Rodriguez, M. Casal.

Antimicrobial susceptibility of bacterial isolates from patients with cystic fibrosis.

Rev Esp Quimioter, 17 (2004), pp. 332-335

Medline

[13.]

R.M. Klevens, M.A. Morrison, J. Nadle, S. Petit, K. Gershman, et al.

Invasive methicillin-resistant Staphylococcus aureus infections in the United States.

JAMA, 298 (2007), pp. 1763-1771

http://dx.doi.org/10.1001/jama.298.15.1763 | Medline

[14.]

K. Purcell, J. Fergie.

Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children¿s Hospital.

Arch Pediatr Adolesc Med, 159 (2005), pp. 980-985

http://dx.doi.org/10.1001/archpedi.159.10.980 | Medline

[15.]

F. Vandenesch, T. Naimi, M.C. Enright, G. Lina, G.R. Nimmo, et al.

Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence.

Emerg Infect Dis, 9 (2003), pp. 978-984

http://dx.doi.org/10.3201/eid0908.030089 | Medline

[16.]

D. Glikman, J.D. Siegel, M.Z. David, N.M. Okoro, S. Boyle-Vavra, et al.

Complex molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates from children with cystic fibrosis in the era of epidemic community-associated methicillin-resistant S. aureus.

Chest, 133 (2008), pp. 1381-1387

http://dx.doi.org/10.1378/chest.07-2437 | Medline

[17.]

A. Vergison, O. Denis, A. Deplano, G. Casimir, G. Claeys, et al.

National survey of molecular epidemiology of Staphylococcus aureus colonization in Belgian cystic fibrosis patients.

J Antimicrob Chemother, 59 (2007), pp. 893-899

http://dx.doi.org/10.1093/jac/dkm037 | Medline

[18.]

J.S. Goodrich, T.N. Sutton-Shields, A. Kerr, J.P. Wedd, M.B. Miller, et al.

Prevalence of community-associated methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis.

J Clin Microbiol, 47 (2009), pp. 1231-1233

http://dx.doi.org/10.1128/JCM.00255-09 | Medline

[19.]

K. Nadesalingam, S.P. Conway, M. Denton.

Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by patients with cystic fibrosis.

J Cyst Fibros, 4 (2005), pp. 49-52

http://dx.doi.org/10.1016/j.jcf.2005.05.018 | Medline

[20.]

S.R. Thomas, K.M. Gyi, H. Gaya, M.E. Hodson.

Methicillin-resistant Staphylococcus aureus (MRSA) – impact at a national cystic fibrosis centre.

J Hosp Infect, 40 (1998), pp. 203-209

Medline

[21.]

R. Gopal, H. Gaya, M. Hodson, et al.

MRSA in cystic fibrosis Meeting report.

J Hosp Infect, 40 (1998), pp. 179-191

Medline

[22.]

L.S. Miall, N.T. McGinley, K.G. Brownlee, S.P. Conway.

Methicillin resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis.

Arch Dis Child, 84 (2001), pp. 160-162

Medline

[23.]

E.C. Dasenbrook, C.A. Merlo, M. Diener-West, N. Lechtzin, M.P. Boyle.

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

Am J Respir Crit Care Med, 178 (2008), pp. 814-821

http://dx.doi.org/10.1164/rccm.200802-327OC | Medline

[24.]

C.L. Ren, W.J. Morgan, M.W. Konstan, M.S. Schechter, J.S. Wagener, et al.

Presence of methicillin resistant Staphylococcus aureus in respiratory cultures from cystic fibrosis patients is associated with lower lung function.

Pediatr Pulmonol, 42 (2007), pp. 513-518

http://dx.doi.org/10.1002/ppul.20604 | Medline

[25.]

R.M. Girón, B. Buendía, C. Pinedo, A. Casanova, N. Hoyos, et al.

Methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis.

Enferm Infecc Microbiol Clin, 27 (2009), pp. 85-88

http://dx.doi.org/10.1016/j.eimc.2008.02.008 | Medline

[26.]

D. Hadjiliadis, M.P. Steele, C. Chaparro, et al.

Survival of lung transplant patients with cystic fibrosis harboring panresistant bacteria other than Burkholderia cepacia, compared with patients harboring sensitive bacteria.

J Heart Lung Transplant, 26 (2007), pp. 834-838

http://dx.doi.org/10.1016/j.healun.2007.05.018 | Medline

[27.]

L.A. Garske, T.J. Kidd, R. Gan, J.P. Bunting, C.A. Franks, et al.

Rifampicin and sodium fusidate reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) isolation in adults with cystic fibrosis and chronic MRSA infection.

J Hosp Infect, 56 (2004), pp. 208-214

http://dx.doi.org/10.1016/j.jhin.2003.12.003 | Medline

[28.]

A. Solís, D. Brown, J. Hughes, H.K. Van Saene, D.P. Heaf.

Methicillin-resistant Staphylococcus aureus in children with cystic fibrosis: an eradication protocol.

Pe diatr Pulmonol, 36 (2003), pp. 189-195

[29.]

R. Cantón, et al.

Tratamiento antimicrobiano frente a la colonización pulmonar por Pseudomonas aeruginosa en el paciente con fibrosis quística.

Arch Bronconeumol, 41 (2005), pp. 1-25

[30.]

P. Reis, S. Castanhinha, J. Fermeiro, L. Pereira, C. Barreto.