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Methicillin-resistant Staphylococcus aureus in cystic fibrosis patients: do we need to care? A cohort study
Renata Wrobel Folescu Cohen1, Tânia Wrobel Folescu2, Pedro Daltro3
1Assistant Professor of Pediatrics, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), and Pediatric Pulmonologist, Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Instituto Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro (RJ), Brazil.
Context And Objective:
The prevalence of a variety of potentially pathogenic microorganisms in cystic fibrosis patients, such as methicillin-resistant Staphylococcus aureus (MRSA), has increased over the past decade. Given the increasing prevalence of MRSA and the few data available in the literature, better understanding of the clinical repercussions of colonization by this bacterium in cystic fibrosis patients becomes essential. This study aimed to evaluate the repercussions of chronic colonization by MRSA in cystic fibrosis patients.
Design And Setting:
Retrospective cohort study from January 2004 to December 2013 in a cystic fibrosis reference center.
Methods:
Each patient with cystic fibrosis was evaluated for nutritional status (body mass index, BMI, and BMI percentile), pulmonary function and tomographic abnormalities (modified Bhalla scores) at the time of chronic colonization by MRSA or methicillin-susceptible Staphylococcus aureus (MSSA) and throughout the study period.
Results:
Twenty pairs of patients were included. There were no significant differences between the groups regarding nutritional characteristics. Spirometric data showed a trend towards greater obstruction of the airways in patients with MRSA. Patients with MRSA presented greater structural damage to their lungs, demonstrated not only by the total Bhalla score but also by its parameters individually.
Conclusions:
Patients colonized by MRSA presented greater functional and structural respiratory impairment at the time of chronic colonization. Disease progression was also faster in patients chronically colonized by MRSA than in those with MSSA. This was shown through comparisons that avoided possible confounding variables.
Insights
Chronic methicillin-resistant Staphylococcus aureus (MRSA) colonization in cystic fibrosis patients leads to worse lung function and structural damage. This MRSA infection also accelerates disease progression compared to methicillin-susceptible Staphylococcus aureus (MSSA).
Area of Science:
- Medical Microbiology
- Pulmonology
- Infectious Diseases
Background:
- Increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients necessitates understanding its clinical impact.
- Limited data exists on the long-term consequences of MRSA colonization in CF.
Purpose of the Study:
- To evaluate the clinical repercussions of chronic MRSA colonization in cystic fibrosis patients.
- To compare the health outcomes of CF patients colonized with MRSA versus MSSA.
Main Methods:
- Retrospective cohort study conducted between 2004 and 2013.
- Inclusion of 20 pairs of cystic fibrosis patients (MRSA vs. MSSA).
- Assessment of nutritional status (BMI), pulmonary function (spirometry), and lung structural damage (modified Bhalla scores).
Main Results:
- No significant differences in nutritional status between MRSA and MSSA groups.
- A trend towards increased airway obstruction in patients colonized with MRSA.
- Greater structural lung damage observed in MRSA-colonized patients.
Conclusions:
- Chronic MRSA colonization is associated with significant functional and structural respiratory impairment in CF patients.
- Disease progression is accelerated in CF patients with chronic MRSA colonization compared to MSSA.
- Findings highlight the detrimental impact of MRSA in cystic fibrosis care.
