The first report of Methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients in Saudi Arabia

Abstract

Introduction Methicillin-resistant Staphylococcus aureus infections have been increasingly reported in patients with cystic fibrosis (CF) who have progressive deterioration in their pulmonary function. Objectives To determine the prevalence of MRSA infections in CF in a tertiary care center in Saudi Arabia. Methodology This is a retrospective chart review conducted as part of the CF registry data from 1 January 2002 to 1 June 2016. All patients with confirmed CF of all age groups who had a respiratory culture positive for MRSA were included in the study. Results Among 385 patients with CF who had respiratory samples, 43 (11%) were positive for MRSA at a mean age of 10.4 ± 7.2 years. Twenty-two patients out of the 43 (51%) were treated with different regimens: nasal Bactroban in 13/22 (59%); a combination of nasal Bactroban, oral vancomycin, and rifampicin for 2 weeks in 5 patients (23%); Bactroban and linezolid in one patient (5%); and oral vancomycin and rifampicin in 3 patients (14%). Eight out of the 22 treated patients (36%) achieved MRSA eradication. Six out of the 22 treated (27%) had experienced MRSA recurrence within 3–6 months, and another 5/22 (23%) continued to have MRSA colonization up to 2–4 years of follow-up despite using a proper eradication protocol. Twelve out of the 43 (28%) patients with MRSA infection died. Conclusion MRSA infection in our population with CF is common. Therefore, an eradication protocol should be instituted at an early stage to prevent chronic colonization. Children with persistent MRSA colonization have high morbidity and mortality rate.

Distribution and Characteristics of Bacteria Isolated from Cystic Fibrosis Patients with Pulmonary Exacerbation

“…identical to our study [35,36]. Several reports have suggested that chronic MRSA infection is associated with a high decline rate of lung function, failure to recover lung function after a pulmonary exacerbation and decreased survival [37,38]. Te prevalence of MRSA in our study was 20% which is similar to Chmiel et al who reported the prevalence of MRSA infection at 25% in the USA, as compared to 11% in Canada and Europe [39].…”

“…In 2008, 50.9% of CF patients included in the cystic fibrosis foundation (CFF) patient registry had positive S. aureus cultures and the most affected groups were children between 6 to 10 and adolescents of 11 to 17 years of age which is identical to our study [ 35 , 36 ]. Several reports have suggested that chronic MRSA infection is associated with a high decline rate of lung function, failure to recover lung function after a pulmonary exacerbation and decreased survival [ 37 , 38 ]. The prevalence of MRSA in our study was 20% which is similar to Chmiel et al who reported the prevalence of MRSA infection at 25% in the USA, as compared to 11% in Canada and Europe [ 39 ].…”

Prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) in Saudi Arabia: A Systematic Review

“…In the United States, prevalence of MRSA infections in patients with cystic fibrosis (CF) has risen from 12% in 2003 to nearly 26% in 2013, with serious lung function impairment and subsequent mortality 44 . In a recent retrospective chart review, MRSA incidence among CF patients in Saudi Arabia was reported to be 11% 45 . Due to serious MRSA complications in CF patients, its eradication must be considered and it was found that a combination of oral rifampicin and nebulized vancomycin remained one of the successful eradication regimens 46 .…”