Treatment decisions for MRSA in patients with cystic fibrosis (CF): when is enough, enough?

Bell, Scott C.; Flume, Patrick A.

doi:10.1136/thoraxjnl-2016-209605

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…Indeed, mean FEV 1 was 1.52% lower (95% CI: −2.98 to −0.06) for every 1-year of age, in agreement with earlier findings. 23 , 24 Thus, older and thinner children are at greater risk for poor lung function, with a mean FEV 1 value that is half of that in younger patients with normal BMI.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Lung Function in Patients with Cystic Fibrosis in Western Romania

Dediu¹,

Ciucă²,

Marc³

et al. 2021

JMDH

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Purpose The aim of this cross-sectional study was to identify the major factors influencing pulmonary function in CF patients from western side of Romania. Patients and Methods The study enrolled 51 patients with CF between the ages of 6 and 27.8 years who were monitored at regular visits to the National Cystic Fibrosis Centre and Pius Branzeu County Hospital in Timisoara, Romania, over a period of 2 years. The relationships between lung function, as measured by forced expiratory volume in 1 s (FEV 1 ), with patient age, sex, body mass index (BMI), pancreatic insufficiency (PI), microbial infection, CF-related diabetes (CFRD), CF-associated liver disease (CFLD), and physical activity <30 min/day, were evaluated by multivariate regression analysis. Results The results showed that FEV1 was 0.32% higher for each increase in percentile of BMI (95% confidence interval: 0.034–0.619). In addition, mean FEV 1 was 1.52% lower with every year rise of age. PI and female sex increased the risk of impaired lung function (FEV 1 <60%). The factors most closely correlated with pulmonary function in pediatric CF patients were current age (negative) and BMI (positive). Conclusion The findings of this study, in combination with what is known from other studies in CF, suggest that a better nutritional status and infection prophylaxis should be part of a comprehensive clinical management strategy for pediatric CF in Romania.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Lung Function in Patients with Cystic Fibrosis in Western Romania

Dediu¹,

Ciucă²,

Marc³

et al. 2021

JMDH

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“…New-generation antibiotics treatment may eradicate the bacterial infection and improve the patients' lung condition, but continuous antibiotic treatment makes bacteria develop resistance to drugs and eventually cause the failure of major commercial antibiotics [2][3][4]. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the severe antibiotic-resistant Gram-positive bacteria, imposing more difficulties on treating CF patients [5][6][7]. MRSA infection elevated shockingly to the 25% of the CF population in the USA in 2015 [8], and higher risk factors for MRSA infection CF patients were identified afterwards [9].…”

Section: Introductionmentioning

confidence: 99%

A novel membrane-disruptive antimicrobial peptide from frog skin secretion against cystic fibrosis isolates and evaluation of anti-MRSA effect using Galleria mellonella model

Yuan

Zai

et al. 2019

Biochimica et Biophysica Acta (BBA) - General Subjects

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Antimicrobial peptides from amphibian skin secretion are a promising source for the development of alternative antibiotics against the urgent antibiotic resistance. Methicillinresistant S. aureus (MRSA) has been found to persist in both early and late disease course of cystic fibrosis (CF). Japonicin-2LF was isolated from the skin secretion of Fujian Large-headed Frog (Limnonectes fujianensis) via the combination of cDNA cloning and MS/MS sequencing.The antimicrobial and anti-biofilm activities of japonicin-2LF were evaluated using both reference and clinic isolated strains. The permeability of the cell membrane treated by the peptide was revealed by fluorescent staining. The cytotoxicity was examined by haemolysis, MTT and LDH assays. Wax moth larvae (Galleria mellonella) infection model was applied to assess the efficacy of japonicin-2LF against the reference and clinic MRSA isolates in vivo.Japonicin-2LF exhibited potent antimicrobial activity, particularly against Gram-positive bacteria Staphylococcus aureus and MRSA, killing the bacteria via membrane permeabilisation. Additionally, Japonicin-2LF demonstrated the inhibition and eradication of biofilms, particularly against the biofilm of MRSA by eradicating the biofilm matrix as well as killing all the sessile bacteria. In the in vivo assay, Japonicin-2LF significantly decreased the mortality of MRSA acute infected larvae. In conclusion, it is a novel antimicrobial peptide discovered from the skin secretion of Limnonectes fujianensis, and particularly effective against both planktonic and sessile MRSA. The further in vivo study suggests that Japonicin-2LF could be a potential drug candidate to control the MRSA infection in cystic fibrosis patients.

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“…Due to the limited experience in the field of MRSA eradication in CF, other studies are definitively necessary. Large-scale studies designed to compare the clinical efficacy of various types of treatments are theoretically feasible [41] but the growing number of patients involved in clinical trials may make it difficult to recruit the number of subjects necessary to reach statistical power. Moreover, running clinical trials on MRSA new infection is made more difficult because of absence of data on MRSA prevalence in certain countries, the need to treat patients with antibiotics potentially active against MRSA and the lack of a universally accepted definition of eradication.…”

Section: Discussionmentioning

confidence: 99%

Methicillin-resistant Staphylococcus aureus eradication in cystic fibrosis patients: A randomized multicenter study

et al. 2019

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BackgroundFew studies, based on a limited number of patients using non-uniform therapeutic protocols, have analyzed Methicillin-resistant Staphylococcus aureus (MRSA) eradication.MethodsIn a randomized multicenter trial conducted on patients with new-onset MRSA infection we evaluated the efficacy of an early eradication treatment (arm A) compared with an observational group (B). Arm A received oral rifampicin and trimethoprim/sulfamethoxazole (21 days). Patients’ microbiological status, FEV1, BMI, pulmonary exacerbations and use of antibiotics were assessed.ResultsSixty-one patients were randomized. Twenty-nine (47.5%) patients were assigned to active arm A and 32 (52.5%) patients to observational arm B. Twenty-nine (47.5%) patients, 10 patients in arm A and 19 in arm B, dropped out of the study. At 6 months MRSA was eradicated in 12 (63.2%) out of 19 patients in arm A while spontaneous clearance was observed in 5 (38.5%) out of 13 patients in arm B. A per-protocol analysis showed a 24.7% difference in the proportion of MRSA clearance between the two groups (z = 1.37, P(Z>z) = 0.08). Twenty-seven patients, 15 (78.9%) out of 19 in arm A and 12 (92.3%) out of 13 in arm B, were able to perform spirometry. The mean (±SD) FEV1 change from baseline was 7.13% (±14.92) in arm A and -1.16% (±5.25) in arm B (p = 0.08). In the same period the BMI change (mean ±SD) from baseline was 0.54 (±1.33) kg/m2 in arm A and -0.38 (±1.56) kg/m2 in arm B (p = 0.08). At 6 months no statistically significant differences regarding the number of pulmonary exacerbations, days spent in hospital and use of antibiotics were observed between the two arms.ConclusionsAlthough the statistical power of the study is limited, we found a 24.7% higher clearance of MRSA in the active arm than in the observational arm at 6 months. Patients in the active arm A also had favorable FEV1 and BMI tendencies.

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Treatment decisions for MRSA in patients with cystic fibrosis (CF): when is enough, enough?

Cited by 7 publications

References 25 publications

Factors Influencing Lung Function in Patients with Cystic Fibrosis in Western Romania

Factors Influencing Lung Function in Patients with Cystic Fibrosis in Western Romania

A novel membrane-disruptive antimicrobial peptide from frog skin secretion against cystic fibrosis isolates and evaluation of anti-MRSA effect using Galleria mellonella model

Methicillin-resistant Staphylococcus aureus eradication in cystic fibrosis patients: A randomized multicenter study

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