Outcomes of a methicillin‐resistant Staphylococcus aureus (MRSA) eradication protocol in pediatric cystic fibrosis (CF) patients

Abstract

Objective Methicillin‐resistant Staphylococcus aureus (MRSA) infections in cystic fibrosis (CF) patients have greatly increased in prevalence in the past two decades and may lead to a more rapid rate of lung function decline. The objective of this study was to determine the impact of a MRSA eradication protocol on long‐term culture results and clinical outcomes of pediatric CF patients in a real‐world setting. Methods This was a single‐center, retrospective study of children age 30 days to 17 years. Eradication followed the STAR‐too study protocol. The primary outcome was the percent of patients with MRSA‐negative cultures at 12 months. Secondary outcomes were the percent of patients with negative cultures at 3, 6, and greater than 12 months and changes in clinical outcomes compared to individual baseline. Results Of the 55 patients who met inclusion criteria, 10 received protocol eradication. Baseline characteristics were similar between eradication and control groups except more eradication patients were on ivacaftor (30% vs 4%; P = .037). Two eradication patients did not receive rifampin due to ivacaftor use. Eradication did not significantly increase the percent of MRSA‐negative cultures at 3 months (P = .122), 6 months (P = .058), or 12 months (P = .108); however, did increase culture negativity at greater than 12 months (P = .008). Eradication resulted in no significant differences in clinical outcomes compared to control. Conclusions An extensive eradication protocol may lead to an increased clearance rate of long‐term CF respiratory cultures but does not appear to affect clinical outcomes. Eradication may be reasonable to attempt; however, more data is needed before routine recommendation in all patients.

Steam disinfection of toothbrushes from patients with cystic fibrosis: Evidence‐based recommendations

“…Over the last number of years there have been several studies that have evaluated the outcomes of MRSA eradication protocols in pediatric and adult patients with CF 32‐35 . However, these remain controversial as long‐term microbiological efficacy and clinical outcomes of such strategies are not fully transparent 36 .…”

“…Therefore, the discretionary decision to eradicate MRSA is based on clinical need. Many may, however, deem this is to be advocated due to the notable increase in the prevalence of MRSA in patients with CF, particularly as noted in the United States, over the past 23 years from 2.1% (1996) to 25.0% (2019) coupled with the rapid deterioration in lung function, particularly if coinfected with P. aeruginosa 32,37‐39 . The first randomized controlled trial, STAR‐too, has been a foundation of several subsequent studies and incorporated several strategies in concert, namely, dual antibiotic therapy, topical decontamination, and environmental decontamination.…”

“…Microbiologically, we paid particular attention to the conven- Over the last number of years there have been several studies that have evaluated the outcomes of MRSA eradication protocols in pediatric and adult patients with CF. [32][33][34][35] However, these remain controversial as long-term microbiological efficacy and clinical outcomes of such strategies are not fully transparent. 36 Therefore, the discretionary decision to eradicate MRSA is based on clinical need.…”

“…(1996) to 25.0% (2019) coupled with the rapid deterioration in lung function, particularly if coinfected with P. aeruginosa. 32,[37][38][39] The first randomized controlled trial, STAR-too, has been a foundation of several subsequent studies and incorporated several strategies in concert, namely, dual antibiotic therapy, topical decontamination, and environmental decontamination. Topical decontamination by whole body cleaning with chlorhexidine wipes and nasal and oral decontamination with mupirocin nasal ointments and chlorhexidine gluconate oral rinses (0.12%; bd; 14 days), respectively, reflecting the need to decontaminate the oral cavity.…”

Cystic fibrosis year in review 2020: Section 2 pulmonary disease, infections, and inflammation

“…To help prevent MRSA disease, real‐world usage and outcomes of an eradication protocol were assessed at a US CF Center 67 . Eradication therapy consisted of two oral Abx (rifampin plus either sulfamethoxazole/trimethoprim or minocycline) combined with topical and environmental decontamination.…”