Interventions to clear meticillin-resistant Staphylococcus aureus (MRSA) from the lungs of people with cystic fibrosis

Review question

We looked for evidence to determine the effect of different ways of clearing meticillin-resistant Staphylococcus aureus (MRSA) from the lungs of people with cystic fibrosis.

Background

Meticillin-resistant Staphylococcus aureus (MRSA), is the name given to a particular bacteria which is resistant to some types of antibiotics. This is particularly worrying for people with cystic fibrosis, which is an inherited condition that causes thick mucus to build up in the lungs. It is very difficult for people with cystic fibrosis to cough up this thick mucus, making it an ideal breeding ground for bacteria, including MRSA, and making these people more prone to chest infections. It is thought that MRSA can cause more damage than other bacteria which are not resistant to antibiotics. We wanted to identify research evidence to support the best way for treating MRSA infections and also to see if this would improve the lives of people with cystic fibrosis.

Search date

The evidence is current to: 04 September 2014.

Key results

Unfortunately, we could not find any trials which compared treating MRSA to not treating MRSA, or which compared one form of treatment to another. We are unable, therefore, to make any recommendations for its management at this point in time.

Authors' conclusions: 

We did not identify any randomised trials which would allow us to make any evidence-based recommendations. Although the results of several non-randomised studies would suggest that, once isolated, the eradication of MRSA is possible; whether this has a significant impact on clinical outcome is still unclear. Further research is required to guide clinical decision making in the management of MRSA infection in cystic fibrosis.

Read the full abstract...
Background: 

Cystic fibrosis is an inherited recessive disorder of chloride transport that is characterised by recurrent and persistent pulmonary infections from resistant organisms that result in lung function deterioration and early mortality in sufferers.

Meticillin-resistant Staphylococcus aureus (MRSA) has emerged as, not only an important infection in long-term hospitalised patients, but also as a potentially harmful pathogen in cystic fibrosis, and has been increasing steadily in prevalence internationally. Chronic pulmonary infection with MRSA is thought to confer cystic fibrosis patients with a worse overall clinical outcome and, in particular, result in an increased rate of decline in lung function. Clear guidance for the eradication of MRSA in cystic fibrosis, supported by robust evidence from good quality trials, is urgently needed.

Objectives: 

To evaluate the effectiveness of treatment regimens designed to eradicate MRSA and to determine whether the eradication of MRSA confers better clinical and microbiological outcomes for people with cystic fibrosis.

Search strategy: 

Randomised and quasi-randomised controlled trials were identified by searching the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, PUBMED, MEDLINE, Embase, handsearching article reference lists and through contact with local and international experts in the field.

Date of the last search of the Group's Cystic Fibrosis Trials Register: 04 September 2014.

Selection criteria: 

Randomised or quasi-randomised controlled trials comparing any combinations of topical, inhaled, oral or intravenous antimicrobials with the primary aim of eradicating MRSA compared with placebo, standard treatment or no treatment.

Data collection and analysis: 

The authors independently assessed all search results for eligibility. No eligible trials were identified for inclusion.

Main results: 

No current published eligible trials were identified, although three ongoing clinical trials are likely to be eligible for inclusion in future updates of this review.

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