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Am J Respir Crit Care Med. 2008 Oct 15;178(8):814-21. doi: 10.1164/rccm.200802-327OC. Epub 2008 Jul 31.

Persistent methicillin-resistant Staphylococcus aureus and rate of FEV1 decline in cystic fibrosis.

Author information

1
Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD 21205, USA. edasenb1@jhmi.edu

Abstract

RATIONALE:

The prevalence in cystic fibrosis (CF) of respiratory cultures with methicillin-resistant Staphylococcus aureus (MRSA) has dramatically increased over the last 10 years, but the effect of MRSA on FEV(1) decline in CF is unknown.

OBJECTIVES:

To determine the association between MRSA respiratory infection and FEV(1) decline in children and adults with CF.

METHODS:

This was a 10-year cohort study using the Cystic Fibrosis Foundation patient registry from 1996-2005. We studied individuals who developed new MRSA respiratory tract infection. Repeated-measures regression was used to assess the association between MRSA and FEV(1) decline, adjusted for confounders, in individuals aged 8-21 years and adults (aged 22-45 yr). Two different statistical models were used to assess robustness of results.

MEASUREMENTS AND MAIN RESULTS:

The study cohort included 17,357 patients with an average follow-up of 5.3 years. During the study period, 1,732 individuals developed new persistent MRSA infection (> or =3 MRSA cultures; average, 6.8 positive cultures) and were subsequently followed for an average of 3.5 years. Even after adjustment for confounders, rate of FEV(1) decline in individuals aged 8-21 years with persistent MRSA was more rapid in both statistical models. Their average FEV(1) decline of 2.06% predicted/year was 43% more rapid than the 1.44% predicted/year in those without MRSA (difference, -0.62% predicted/yr; 95% confidence interval, -0.70 to -0.54; P < 0.001). Effect of MRSA on FEV(1) decline in adults was not clinically significant.

CONCLUSIONS:

Persistent infection with MRSA in individuals with CF between the ages of 8 and 21 years is associated with a more rapid rate of decline in lung function.

PMID:
18669817
DOI:
10.1164/rccm.200802-327OC
[Indexed for MEDLINE]
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