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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