Microbiological efficacy of early MRSA treatment in cystic fibrosis in a randomised controlled trial. Issue 4 (15th November 2016)

• Record Type: Journal Article
• Authors: Muhlebach, Marianne Sponer; Beckett, Valeria; Popowitch, Elena; Miller, Melissa B; Baines, Arthur; Mayer-Hamblett, Nicole; Zemanick, Edith T; Hoover, Wynton C; VanDalfsen, Jill M; Campbell, Preston; Goss, Christopher H
• Other Names: author non-byline.; Ng Debbie author non-byline.; McNamara John author non-byline.; Johnson Mahrya author non-byline.; Moonnumakal Silby author non-byline.; Schaap Nicoline author non-byline.; Anthony Meg author non-byline.; Clancy John P author non-byline.; Gibson Ronald author non-byline.; McNamara Sharon author non-byline.; Michelson Peter author non-byline.; Hicks Tina author non-byline.; Sharma Preeti author non-byline.; Hebert Andrew author non-byline.; Brand Katie author non-byline.; Schuler Pamela author non-byline.; Baker Dawn author non-byline.; Filbrun Amy author non-byline.; Linn Marisa author non-byline.; Sammut Paul author non-byline.; Telfer Raquel author non-byline.; Moormann Kelly author non-byline.; Schultz Karen author non-byline.; Urbanek Heather author non-byline.; Guill Margaret author non-byline.; LiPuma John J author non-byline.; Sontag Marci author non-byline.; Murray Susan author non-byline.; Hunt Miriam author non-byline.; Howe Dianne L. author non-byline.; Hocevar-Trnka Jasna author non-byline.; Mitchell Rose author non-byline.; Browne Lynette author non-byline.;
• Is Part Of: Thorax. Volume 72:Issue 4(2017)
• Page Start: 318
• Page End: 326
• Publication Date: 2016-11-15
• Subjects: Cystic Fibrosis -- Bacterial Infection -- Infection Control; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2016-208949
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Objective: To evaluate microbiological effectiveness, that is, culture negativity of a non-blinded eradication protocol (Rx) compared with observation (Obs) in clinically stable cystic fibrosis participants with newly positive methicillin resistant Staphylococcus aureus (MRSA) cultures. Design: This non-blinded trial randomised participants ages 4–45 years with first or early (≤2 positive cultures within 3 years) MRSA-positive culture without MRSA-active antibiotics within 4 weeks 1:1 to Rx or Obs. The Rx protocol was: oral trimethoprim-sulfamethoxazole or if sulfa-allergic, minocycline plus oral rifampin; chlorhexidine mouthwash for 2 weeks; nasal mupirocin and chlorhexidine body wipes for 5 days and environmental decontamination for 21 days. The primary end point was MRSA culture status at day 28. Results: Between 1 April 2011 to September 2014, 45 participants (44% female, mean age 11.5 years) were randomised (24 Rx, 21 Obs). At day 28, 82% (n=18/22) of participants in the Rx arm compared with 26% (n=5/19) in the Obs arm were MRSA-negative. Adjusted for interim monitoring, this difference was 52% (95% CI 23% to 80%, p<0.001). Limiting analyses to participants who were MRSA-positive at the screening visit, 67% (8/12) in the Rx arm and 13% (2/15) in the Obs arm were MRSA-negative at day 28, adjusted difference: 49% (95% CI 22% to 71%, p<0.001). Fifty-four per cent in the Rx arm compared with 10% participants in the Obs arm remained MRSA-negative through day 84. Mild gastrointestinal side effects were higher in the Rx arm. Conclusions: This MRSA eradication protocol for newly acquired MRSA demonstrated microbiological efficacy with a large treatment effect. Trial registration number: NCT01349192 .