(505) MRSA Eradication Rate Increased After the Initiation of a Standardized Regimen in Children with Cystic Fibrosis

Background: Chronic Methicillin-resistant Staphylococcus aureus (MRSA) infection is associated with deterioration of pulmonary disease and decline in lung function in patients with cystic fibrosis (pwCF). Thus, an early eradication of MRSA was reported to be beneficial in pwCF. Our primary aim was to determine the efficacy of the standardized MRSA eradication regimen. Our secondary aim was to evaluate the changes in BMI and FEV1 values during the follow-up period after MRSA detection.

Methods: pwCF in whom MRSA was detected for the first time or not grown during the previous year in respiratory tract samples were included in the study. Eradication is defined as negative MRSA respiratory cultures (at least three samples) during the 12 months following the eradication treatment. First-line antibiotic regimen for the eradication of MRSA was: peroral trimethoprim-sulfamethoxazole and rifampicin or sodium fusidate and rifampicin for 3 weeks (intravenous antibiotics if the patient is unwell). Body cleaning, environmental decontamination and nasal mupirocin was used as an adjuvant therapy. If MRSA growth was observed again during the 1-year follow-up period after the peroral eradication treatment, IV antibiotics was used as a second-line eradication protocol.

Results: 21 CF patients were included in the study. The median age of patients at first MRSA isolation was 8 years (25th-75th p was 4,5-12 years) and at diagnosis of CF was 3 months (25th-75th p was 1,5-5.5 month). There were no new-onset symptoms 66.7% (n=14) of the patients. Oral trimethoprim-sulfamethoxazole and rifampicin were used in 54,1% of the patients (n=13), oral sodium fusidate and trimethoprim-sulfamethoxazole in 23,8% (n=5). IV antibiotics as initial treatment were used in 9,5% (n=2) of the patients. IV antibiotics were required due to MRSA regrowth in five patients, during the follow-up period. Eradication was successful in 85,7% (n=18) of patients. There was no significant difference in baseline and 12th month BMI and FEV1 values of patients.

Conclusions: This study demonstrated that standardized MRSA eradication protocol was applied successfully and the eradication rate was high.

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