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PLoS One. 2019 Mar 22;14(3):e0213497. doi: 10.1371/journal.pone.0213497. eCollection 2019.

Methicillin-resistant Staphylococcus aureus eradication in cystic fibrosis patients: A randomized multicenter study.

Author information

1
Cystic Fibrosis Center, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy.
2
Department of Health Sciences, University of Florence, Florence, Italy.
3
Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy.
4
Cystic Fibrosis Microbiology and Cystic Fibrosis Center, Children's Hospital and Research Institute Bambino Gesù, Rome, Italy.
5
Laboratory for Cystic Fibrosis Microbiology, Fondazione IRCCS, Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
6
Cystic Fibrosis Center, University of Milan, Fondazione IRCCS, Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
7
Cystic Fibrosis and Pediatric Gastroenterology Unit, University of Messina, Messina, Italy.
8
Department of Translational Medical Sciences, Pediatric Cystic Fibrosis Center, Federico II University, Naples, Italy.
9
Center for Integrative Biology, University of Trento, Trento, Italy.

Abstract

BACKGROUND:

Few studies, based on a limited number of patients using non-uniform therapeutic protocols, have analyzed Methicillin-resistant Staphylococcus aureus (MRSA) eradication.

METHODS:

In a randomized multicenter trial conducted on patients with new-onset MRSA infection we evaluated the efficacy of an early eradication treatment (arm A) compared with an observational group (B). Arm A received oral rifampicin and trimethoprim/sulfamethoxazole (21 days). Patients' microbiological status, FEV1, BMI, pulmonary exacerbations and use of antibiotics were assessed.

RESULTS:

Sixty-one patients were randomized. Twenty-nine (47.5%) patients were assigned to active arm A and 32 (52.5%) patients to observational arm B. Twenty-nine (47.5%) patients, 10 patients in arm A and 19 in arm B, dropped out of the study. At 6 months MRSA was eradicated in 12 (63.2%) out of 19 patients in arm A while spontaneous clearance was observed in 5 (38.5%) out of 13 patients in arm B. A per-protocol analysis showed a 24.7% difference in the proportion of MRSA clearance between the two groups (z = 1.37, P(Z>z) = 0.08). Twenty-seven patients, 15 (78.9%) out of 19 in arm A and 12 (92.3%) out of 13 in arm B, were able to perform spirometry. The mean (±SD) FEV1 change from baseline was 7.13% (±14.92) in arm A and -1.16% (±5.25) in arm B (p = 0.08). In the same period the BMI change (mean ±SD) from baseline was 0.54 (±1.33) kg/m2 in arm A and -0.38 (±1.56) kg/m2 in arm B (p = 0.08). At 6 months no statistically significant differences regarding the number of pulmonary exacerbations, days spent in hospital and use of antibiotics were observed between the two arms.

CONCLUSIONS:

Although the statistical power of the study is limited, we found a 24.7% higher clearance of MRSA in the active arm than in the observational arm at 6 months. Patients in the active arm A also had favorable FEV1 and BMI tendencies.

PMID:
30901344
PMCID:
PMC6430412
DOI:
10.1371/journal.pone.0213497
[Indexed for MEDLINE]
Free PMC Article

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