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Elliott C Dasenbrook¹, William Checkley, Christian A Merlo

¹Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio 44106-5067, USA. ecd28@case.edu

|June 17, 2010

Resumen

La detección de Staphylococcus aureus resistente a la meticilina (MRSA) en pacientes con fibrosis quística (CF) está relacionada con un aumento de la mortalidad. Este estudio pone de relieve el impacto significativo de MRSA en las tasas de supervivencia en individuos con FQ.

Área de la Ciencia:

Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
Enfermedades infecciosas Enfermedades infecciosas.
Epidemiología Clínica Epidemiología clínica.

Sus antecedentes:

El aumento de la prevalencia de Staphylococcus aureus resistente a la meticilina (MRSA) en las vías respiratorias de los pacientes con fibrosis quística (FC).
Incertidumbre con respecto al impacto de MRSA en los resultados de los pacientes con FQ.
Necesidad de estudios observacionales a largo plazo debido a la línea de tiempo de décadas entre la infección y la mortalidad en CF.

Objetivo del estudio:

Investigar la asociación entre el aislamiento de MRSA del tracto respiratorio y la supervivencia en pacientes con FQ.
Para comparar las tasas de supervivencia de pacientes con FQ con y sin detección de MRSA.
Para cuantificar el impacto de MRSA en el riesgo de mortalidad en la población CF.

Principales métodos:

Un estudio de cohorte que involucró a 19.833 pacientes con FQ de entre 6 y 45 años en centros acreditados en los Estados Unidos.
Datos de pacientes recopilados entre enero de 1996 y diciembre de 2006, con seguimiento hasta diciembre de 2008.
Se emplearon modelos de regresión de Cox con covariables variables en el tiempo para analizar los datos de supervivencia.

Principales resultados:

A lo largo de 137.819 pacientes-años, se detectó SARM en 5.759 pacientes y murieron 2.537 pacientes con FQ.
Las tasas de mortalidad fueron más altas en pacientes con SARM (27.7/1000 pacientes-año) en comparación con aquellos sin (18.3/1000 pacientes-año).
El SARM se asoció de forma independiente con un aumento del 27% en el riesgo de muerte (razón de riesgo ajustada, 1,27; IC del 95%, 1,11-1,45).

Conclusiones:

La detección de MRSA en el tracto respiratorio de los pacientes con FQ se asocia significativamente con una menor supervivencia.
El MRSA contribuye a un mayor riesgo de mortalidad en individuos con fibrosis quística.
Estos hallazgos subrayan la importancia de monitorear y manejar el MRSA en el cuidado de la FQ.

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