Update on the epidemiology and management of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, in patients with cystic fibrosis.
OBJECTIVE
Staphylococcus aureus is one of the first and most common pathogens to be isolated from the respiratory tract of patients with cystic fibrosis. The prevalence of respiratory tract colonization/infection with both methicillin-susceptible and methicillin-resistant S. aureus has increased over the past decade. The clinical significance of colonization/infection with these pathogens is variable, leading to numerous therapeutic strategies: primary prophylaxis, eradication, treatment of cystic fiboris pulmonary exacerbations, and treatment of methicillin-resistant S. aureus.


RESULTS
Studies have demonstrated increased prevalence of S. aureus in clinical laboratories that use selective media. Additionally, small colony variant S. aureus has been associated with persistent infection, co-infection with Pseudomonas aeruginosa, and frequent courses of antibiotics, but this phenotype may be difficult to identify in clinical laboratories. Increased prevalence of methicillin-resistant S. aureus has led to use of oral and inhaled antibiotics in attempts to eradicate this pathogen; these studies have yielded variable results.


CONCLUSIONS
The epidemiology of S. aureus in cystic fibrosis has changed. Studies are needed to assess the clinical significance of the increased prevalence of both methicillin-susceptible and methicillin-resistant S. aureus, and whether primary prophylaxis or new treatment/eradication protocols are effective.
Stone
Anne
A
Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital, New York, New York 10032, USA. ans9079@nyp.org
Saiman
Lisa
L
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003550:Cystic Fibrosis / Q000150:complications*; D014943:Global Health; D006801:Humans; D008712:Methicillin / Q000627:therapeutic use*; D016106:Methicillin Resistance; D015995:Prevalence; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D014774:Virulence
D000900:Anti-Bacterial Agents; D008712:Methicillin