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

Garske, Luke; Kidd, Timothy J.; Gan, Ren‐You; Bunting, J.; Franks, C.; Coulter, Christopher; Masel, P.; Bell, Scott C.

doi:10.1016/j.jhin.2003.12.003

Cited by 61 publications

(54 citation statements)

References 11 publications

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“…An eradication program for pediatric patients with newly acquired B. cepacia complex infection may be a significant factor for this difference, and there is some support in the literature for this idea (37). However, spontaneous clearance may also occur, as we have demonstrated in patients with methicillin-resistant Staphylococcus aureus infection (38).…”

Section: Discussionmentioning

confidence: 71%

Factors Influencing Acquisition of Burkholderia cepacia Complex Organisms in Patients with Cystic Fibrosis

et al. 2013

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dBurkholderia cepacia complex organisms are important transmissible pathogens found in cystic fibrosis (CF) patients. In recent years, the rates of cross-infection of epidemic strains have declined due to effective infection control efforts. However, cases of sporadic B. cepacia complex infection continue to occur in some centers. The acquisition pathways and clinical outcomes of sporadic B. cepacia complex infection are unclear. We sought to determine the patient clinical characteristics, outcomes, incidence, and genotypic relatedness for all cases of B. cepacia complex infection at two CF centers. We also sought to study the external conditions that influence the acquisition of infection. From 2001 to 2011, 67 individual organisms were cultured from the respiratory samples of 64 patients. Sixty-five percent of the patients were adults, in whom chronic infections were more common (68%) (P ‫؍‬ 0.006). The incidence of B. cepacia complex infection increased by a mean of 12% (95% confidence interval [CI], 3 to 23%) per year. The rates of transplantation and death were similar in the incident cases who developed chronic infection compared to those in patients with chronic Pseudomonas aeruginosa infection. Multilocus sequence typing revealed 50 individual strains from 65 isolates. Overall, 85% of the patients were infected with unique strains, suggesting sporadic acquisition of infection. The yearly incidence of nonepidemic B. cepacia complex infection was positively correlated with the amount of rainfall in the two sites examined: subtropical Brisbane (r ‫؍‬ 0.65, P ‫؍‬ 0.031) and tropical Townsville (r ‫؍‬ 0.82, P ‫؍‬ 0.002). This study demonstrates that despite strict cohort segregation, new cases of unrelated B. cepacia complex infection continue to occur. These data also support an environmental origin of infection and suggest that climate conditions may be associated with the acquisition of B. cepacia complex infections.

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Section: Discussionmentioning

confidence: 71%

Factors Influencing Acquisition of Burkholderia cepacia Complex Organisms in Patients with Cystic Fibrosis

et al. 2013

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“…Several small studies did not find an association between MRSA infection and increased mortality or deterioration of lung function in CF patients (208,397,602). Likewise, a retrospective study that evaluated a treatment protocol for eradication of MRSA carriage in 15 CF patients did not find an improvement in pulmonary function in patients who became MRSA free (564).…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

et al. 2011

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SUMMARY A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.

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“…[1][2][3][4][5][6] Vancomycin (VAN) has become a primary treatment option due to the increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolates; [1][2][3][4] however, with the emergence of S. aureus strains with increased VAN minimum inhibitory concentrations (MIC), decreased susceptibility, as well as clinical failures and potential nephrotoxicity, alternative regimens including trimethoprim-sulfamethoxazole, linezolid (LZD), and rifampin have been investigated. [2,[7][8][9]10] Although there are a lack of data on the benefits of treating MRSA in CF patients, it is known that MRSA colonization may lead to increased systemic antibiotic use and potential lengthy hospitalizations that are costly to the healthcare system. [11,12] The purpose of this case series study was to evaluate a comprehensive protocol of clinical, microbiological, and radiological outcomes in hospitalized CF patients receiving either LZD or VAN for treatment of MRSA.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Linezolid and Vancomycin in the treatment of Methicillin-Resistant Staphylococcus aureus(MRSA) in Cystic Fibrosis Patients

Caulder

Bookstaver²,

Brown

et al. 2013

International Journal of Pharmacology and Toxicology

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Background: Cystic fibrosis (CF) patients often have pulmonary colonization with multiple organisms, including methicillin-resistant Staphylococcus aureus (MRSA), resulting in frequent hospitalizations and decreased quality of life. The pupose of this study was to evaluate the effectiveness of linezolid (LZD) and vancomycin (VAN) in the treatment of MRSA in the CF population. Methods: A prospective, pilot study was conducted in CF patients with pulmonary exacerbation and sputum culture positive for MRSA randomized to receive intravenous LZD or VAN. The primary endpoint was microbiological eradication of MRSA and secondary endpoints included Kanga Clinical Score and change in quality of life questionaire (CF QOL) score. Patients were followed for 6 months post treatment. The ability to conduct a comprehensive outcome protocol in this population at a children's hospital was also evaluated. Results: Eight subjects were randomized to receive LZD (n=5) or VAN (n=3), with average duration of therapy of 19.8 and 21 days, respectively. The primary endpoint of microbiological eradication at end of treatment (EOT) was achieved in 3 patients treated with LZD and 2 with VAN. Kanga Clinical Scores calculated at baseline and EOT showed a significant decrease in all subjects from a median of 26/50 to 16/50. Six patients or caregivers completed the CF QOL questionnaire. Five patients (2 treated with LZD, 3 with VAN) had improvements in CFQOL scores at EOT. No clinically significant adverse events were noted. Conclusions: VAN and LZD were clinically effective and well tolerated in the treatment of MRSA in our CF population. Eradication of MRSA was less likely in patients with long-standing infection. Comprehensive study protocols such as this may be utilized in a large, randomized controlled trial to determine standardized treatment for newly acquired MRSA in CF patients.

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

Cited by 61 publications

References 11 publications

Factors Influencing Acquisition of Burkholderia cepacia Complex Organisms in Patients with Cystic Fibrosis

Factors Influencing Acquisition of Burkholderia cepacia Complex Organisms in Patients with Cystic Fibrosis

Clinical Significance of Microbial Infection and Adaptation in Cystic Fibrosis

Evaluation of Linezolid and Vancomycin in the treatment of Methicillin-Resistant Staphylococcus aureus(MRSA) in Cystic Fibrosis Patients

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