Methicillin resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis.
BACKGROUND
Methicillin resistant Staphylococcus aureus (MRSA) infection is increasingly found in patients with cystic fibrosis (CF).


OBJECTIVE
To determine whether MRSA infection has a deleterious effect on the clinical status of children with CF.


METHODS
Children with MRSA in respiratory cultures during a seven year period were identified and compared with controls matched for age, sex, and respiratory function. Respiratory function tests, anthropometric data, Shwachman-Kulczycki score, Northern chest x ray score, intravenous and nebulised antibiotic therapy, and steroid therapy were compared one year before and one year after MRSA infection.


RESULTS
From a clinic population of 300, 10 children had positive sputum or cough swab cultures for MRSA. Prevalence rose from 0 in 1992-1994 to 7 in 1998. Eighteen controls were identified. Children with MRSA showed significant worsening of height standard deviation scores and required twice as many courses of intravenous antibiotics as controls after one year. They had significantly worse chest x ray scores at the time of the first MRSA isolate and one year later, but showed no increase in the rate of decline in chest x ray appearance. There was a trend towards lower FEV(1) and FEF(25-75) in children with MRSA. There were no significant differences between the two groups with respect to change in weight, body mass index, or Shwachman score. There was no significant difference in prior use of steroids or nebulised antibiotics.


CONCLUSIONS
MRSA infection in children with CF does not significantly affect respiratory function, but may have an adverse effect on growth. Children with MRSA require significantly more courses of intravenous antibiotics and have a worse chest x ray appearance than controls.
Miall
L S
LS
Regional Paediatric Cystic Fibrosis Unit, Children's Day Hospital, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Lawrence@drmiall.freeserve.co.uk
McGinley
N T
NT
Brownlee
K G
KG
Conway
S P
SP
D000293:Adolescent; D000886:Anthropometry; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008450:Maximal Midexpiratory Flow Rate; D016106:Methicillin Resistance; D009752:Nutritional Status; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D013211:Staphylococcus aureus; D018709:Statistics, Nonparametric; D014797:Vital Capacity