Respiratory Division, University Hospital UZ Brussel, 1090 Brussels, Belgium; Cystic Fibrosis Center, University Hospital UZ Brussel, 1090 Brussels, Belgium.
J Cyst Fibros. 2013 Dec;12(6):662-6. doi: 10.1016/j.jcf.2013.04.009. Epub 2013 May 21.
Chronic airway infection with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis (CF) is an increasing clinical problem, and therapeutic options are limited. Because chronic infection with MRSA can be associated with accelerated decline in lung function, eradication of MRSA is attempted in most CF centres today. The aim of this observational prospective cohort study was to determine whether it is possible to eradicate MRSA from airways of CF patients using prolonged oral antibiotic combination therapy together with topical decolonization measures.
Eleven CF patients, (median age: 9 years (range 1-43); median FEV1: 91%pred (95%CI 74%-100%pred)) who were chronically infected with MRSA, were treated daily for six months with rifampicin and fusidic acid orally. This study did not include a patient control group. Two patients had to switch to an alternative schedule, using rifampicin and clindamycin, due to the resistance pattern of MRSA. Topical decolonization measures were applied to all patients and included mupirocin-containing nasal ointment in both nostrils three times daily for five days and chlorhexidine hair and body wash once daily for five days. Microbiological eradication was achieved in all patients at the end of the six-month eradication protocol, even when significant time (range 18 months to 9 years) had elapsed since initial isolation. In only one patient MRSA reappeared in the six-month follow-up period after the initial study period. Side-effects, like nausea, vomiting and diarrhoea were seen in five out of eleven patients, but did not lead to therapy cessation.
Chronic MRSA infection can be eradicated from respiratory tract samples using a six month dual antibiotic regimen and topical MRSA decolonization measures.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的慢性气道感染是囊性纤维化（CF）患者日益严重的临床问题，治疗选择有限。由于 MRSA 的慢性感染可能与肺功能加速下降有关，因此目前大多数 CF 中心都试图清除 MRSA。本观察性前瞻性队列研究的目的是确定使用长期口服抗生素联合治疗和局部去定植措施是否可以从 CF 患者的气道中根除 MRSA。
11 例慢性感染 MRSA 的 CF 患者（中位年龄：9 岁（范围 1-43）；中位 FEV1：91%预测值（95%CI 74%-100%预测值））接受利福平和夫西地酸口服治疗，每日一次，持续六个月。本研究未包括患者对照组。由于 MRSA 的耐药模式，有 2 名患者不得不改用利福平和克林霉素替代方案。所有患者均接受局部去定植措施，包括每天三次在两个鼻孔中使用含有莫匹罗星的鼻腔软膏 5 天，每天一次使用洗必泰洗发水和沐浴露 5 天。所有患者在为期六个月的清除方案结束时均实现了微生物清除，即使在最初分离后已经过去了很长时间（范围 18 个月至 9 年）。在最初研究期后的六个月随访期间，只有 1 名患者再次出现 MRSA。11 例中有 5 例出现了恶心、呕吐和腹泻等副作用，但并未导致治疗停止。
使用六个月的双重抗生素方案和局部去定植措施，可以从呼吸道样本中根除慢性 MRSA 感染。
