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Methicillin resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis
L S Miall1, N T McGinley, K G Brownlee
1Regional Paediatric Cystic Fibrosis Unit, Children's Day Hospital, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Lawrence@drmiall.freeserve.co.uk
Background:
Methicillin resistant Staphylococcus aureus (MRSA) infection is increasingly found in patients with cystic fibrosis (CF).
Aims:
To determine whether MRSA infection has a deleterious effect on the clinical status of children with CF.
Methods:
Children with MRSA in respiratory cultures during a seven year period were identified and compared with controls matched for age, sex, and respiratory function. Respiratory function tests, anthropometric data, Shwachman-Kulczycki score, Northern chest x ray score, intravenous and nebulised antibiotic therapy, and steroid therapy were compared one year before and one year after MRSA infection.
Results:
From a clinic population of 300, 10 children had positive sputum or cough swab cultures for MRSA. Prevalence rose from 0 in 1992-1994 to 7 in 1998. Eighteen controls were identified. Children with MRSA showed significant worsening of height standard deviation scores and required twice as many courses of intravenous antibiotics as controls after one year. They had significantly worse chest x ray scores at the time of the first MRSA isolate and one year later, but showed no increase in the rate of decline in chest x ray appearance. There was a trend towards lower FEV(1) and FEF(25-75) in children with MRSA. There were no significant differences between the two groups with respect to change in weight, body mass index, or Shwachman score. There was no significant difference in prior use of steroids or nebulised antibiotics.
Conclusion:
MRSA infection in children with CF does not significantly affect respiratory function, but may have an adverse effect on growth. Children with MRSA require significantly more courses of intravenous antibiotics and have a worse chest x ray appearance than controls.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) infection in children with cystic fibrosis (CF) impacts growth and increases antibiotic needs. While respiratory function remains largely unaffected, MRSA is linked to poorer chest X-ray outcomes.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Medical Microbiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly prevalent in pediatric cystic fibrosis (CF) patients.
- Understanding the clinical impact of MRSA in this vulnerable population is crucial.
Purpose of the Study:
- To investigate the deleterious effects of MRSA infection on the clinical status of children with CF.
- To compare clinical outcomes in CF patients with and without MRSA infection.
Main Methods:
- A retrospective cohort study comparing 10 children with MRSA to 18 matched controls over a seven-year period.
- Evaluated respiratory function, anthropometrics, Shwachman-Kulczycki scores, chest X-ray, and antibiotic/steroid therapy.
Main Results:
- Children with MRSA showed significantly worse height standard deviation scores and required double the courses of intravenous antibiotics.
- Worse chest X-ray scores were observed in MRSA patients at the time of isolation and one year later.
- A trend towards lower FEV1 and FEF25-75 was noted, but no significant impact on weight, BMI, or Shwachman scores.
Conclusions:
- MRSA infection in pediatric CF patients does not significantly impair respiratory function.
- MRSA infection is associated with adverse effects on growth and increased healthcare utilization (IV antibiotics).
- MRSA is linked to poorer chest imaging findings in children with CF.