MRSA Article

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Original Article

Methicillin-resistant Staphylococcus aureus in children with cystic fibrosis:

An eradication protocol

A. Solís, MD 1 *, D. Brown, MSc 2, J. , MSc 2, H.K.F. van Saene, MD,

PhD, FRCPath 2, D.P. Heaf, MD, MBBS, FRCPCH, FRCP 1

1Respiratory Unit, Royal Liverpool Children's Hospital (Alder Hey), N.H.S.

Trust, Liverpool, United Kingdom

2Department of Clinical Microbiology and Infection Control, Royal Liverpool

Children's Hospital (Alder Hey), N.H.S. Trust, Liverpool, United Kingdom

email: A. Solís (<A

HREF= " mailto:artusol@... " >artusol@...</A>)

*Correspondence to A. Solís, Servicio de Neumología, Hospital Nacional de

Niños. San José, Costa Rica. Central America.setDOI( " ADOI=10.1002/ppul.10231 " )

Keywords

cystic fibrosis • methicillin-resistant Staphylococcus aureus • nebulized

vancomycin • oral vancomycin

Abstract

A retrospective 12-year study (May 1988-July 2000) was undertaken in children

with cystic fibrosis (CF) to evaluate 1) the magnitude of

methicillin-resistant Staphylococcus aureus (MRSA) in these children; 2) the

clinical impact of

MRSA on CF; and 3) the efficacy of an MRSA protocol aimed at the eradication of

the carrier state. The study maneuver comprised of 1) surveillance cultures

of throat/rectum to detect the MRSA carrier state; 2) life-long cephradine

rather than flucloxacillin to lift selection pressure; 3) topical application of

oral and nebulized vancomycin for 5 days to clear the carriage of MRSA; and 4)

a strict antistaphylococcal hygiene program, including handwashing and device

policy. Fifteen children with CF (11 boys, with median age 117 months)

positive for MRSA were enrolled. The current prevalence of MRSA among children

with

CF in our hospital is 6.5%. Of 15 children identified, only 12 (18 episodes of

MRSA colonization) were treated according to protocol. Median age of MRSA

acquisition was 73 months (interquartile range, 43-134 months). In 7 patients

(55%), MRSA was eradicated. Of a total of 18 MRSA episodes, the protocol was

successful in 10 episodes. The mean period of MRSA-free status was 12 months

(range, 6-36 months). Pulmonary function (measured by FEV1) was not affected

(68% of

predicted before treatment, and 68% of predicted after treatment). All

children were oropharyngeal carriers of both MRSA and ceftazidime-resistant P.

aeruginosa. We believe that an effort has to be made to limit MRSA in CF clinics

for the following reasons: 1) MRSA carriage in any individual is an abnormal

condition; 2) limitation of systemic vancomycin use is desirable; 3) MRSA

carriage may be a contraindication for lung transplantation; and 4)

epidemiologically, a CF unit with a substantial MRSA problem functions as a

source of

dissemination for other patients. Pediatr Pulmonol. 2003; 36:189-195. © 2003

Wiley-Liss, Inc.

Received: 28 February 2001; Accepted: 10 October 2002Digital Object

Identifier (DOI)

10.1002/ppul.10231  <A

HREF= " http://www3.interscience.wiley.com/doiinfo.html " >About DOI</A>

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