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Published on: April 19, 2024
Risk factors for persistent methicillin-resistant Staphylococcus aureus infection in cystic fibrosis
Mark T Jennings1, Elliot C Dasenbrook2, Noah Lechtzin1
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Background:
Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen in cystic fibrosis (CF). Over 25% of individuals in the United States with CF are found to have MRSA in respiratory culture specimens, and persistent MRSA infection has been associated with more rapid decline in lung function and increased mortality. The objective of this study was to investigate clinical and demographic characteristics that are associated with the development of persistent MRSA infection in a CF population.
Methods:
This was a retrospective cohort study of individuals followed from 2002 to 2012 in the Cystic Fibrosis Foundation Patient Registry. A time-to-event analysis for the development of persistent MRSA infection was performed, and multivariable Cox proportional hazards models were constructed to identify risk factors for infection.
Results:
The study cohort included 19,434 individuals, of which 5844 would develop persistent MRSA infection. In the adjusted model, pancreatic insufficiency (HR: 1.49; 95% CI: 1.29-1.72), CF related diabetes (HR: 1.13; 95% CI: 1.05-1.20), co-infection with P. aeruginosa (HR: 1.21; 95% CI: 1.13-1.28), and number of hospitalizations/year (HR: 1.09; 95% CI: 1.06-1.12) were all associated with increased risk, whereas higher socio-economic status (HR: 0.87; 95% CI: 0.82-0.93) was associated with a lower risk. Receiving care at a CF center with increased MRSA prevalence was associated with increased risk of MRSA infection: highest quartile (HR: 2.33; 95% CI: 2.13-2.56).
Conclusions:
No easily modifiable risk factors for persistent MRSA were identified in this study. However, several risk factors for patients at higher risk for persistent MRSA infection were identified, for example centers with a high baseline MRSA prevalence, and may be useful in designing center-specific MRSA infection prevention and control strategies and/or eradication protocols. Additional studies are needed in order to evaluate if attention to these risk factors can improve clinical outcomes.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) is a growing threat in cystic fibrosis (CF) care. This study identified risk factors for persistent MRSA infection, including pancreatic insufficiency and CF-related diabetes, to inform prevention strategies.
Area of Science:
- Medical Research
- Infectious Diseases
- Pulmonology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen in cystic fibrosis (CF) patients.
- Over 25% of US CF patients have MRSA in respiratory cultures.
- Persistent MRSA infection is linked to faster lung function decline and increased mortality.
Purpose of the Study:
- To investigate clinical and demographic characteristics associated with persistent MRSA infection in CF patients.
- To identify risk factors for the development of persistent MRSA in this population.
Main Methods:
- Retrospective cohort study using the Cystic Fibrosis Foundation Patient Registry (2002-2012).
- Time-to-event analysis for persistent MRSA infection.
- Multivariable Cox proportional hazards models to identify risk factors.
Main Results:
- The study included 19,434 individuals; 5844 developed persistent MRSA.
- Risk factors for persistent MRSA included pancreatic insufficiency, CF-related diabetes, Pseudomonas aeruginosa co-infection, and higher hospitalization rates.
- Higher socioeconomic status was associated with lower risk.
- Care at CF centers with high MRSA prevalence increased infection risk (HR: 2.33).
Conclusions:
- No easily modifiable risk factors for persistent MRSA were identified.
- Identified risk factors, such as high center MRSA prevalence, can inform targeted prevention and control strategies.
- Further research is needed to evaluate the impact of addressing these risk factors on clinical outcomes.
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