Treatment for chronic Staphylococcus aureus chest infection in people with cystic fibrosis

Review question

We looked for evidence to see whether long-term antibiotic treatment for chronic infection with methicillin-sensitive Staphylococcus aureus (MSSA) in people with cystic fibrosis would lead to improved clinical outcomes and better results for measures of infection

Background

Cystic fibrosis is an inherited condition that causes thick mucus to build up in the lungs leading to persistent infection with bacteria. Methicillin-sensitive Staphylococcus aureus (also known as MSSA), is the name given to a particular bacteria which is a common cause of lung infection in people with cystic fibrosis. It can cause long-term infection in people with cystic fibrosis which leads to worsening lung function and poor overall clinical outcome. There are currently no guidelines based on trial results to inform clinicians how best to treat this infection in people with cystic fibrosis.

Search date

The evidence is current to: 03 March 2016.

Study characteristics

We found 55 trials in our searches, but could not find any which compared different treatments for this condition in people with cystic fibrosis. Therefore, none of these trials were eligible for inclusion in the current version of this review.

Key results

Although methicillin-sensitive Staphylococcus aureus is an important and common cause of lung infection in people with cystic fibrosis, there is no agreement on how best to treat long-term infection. The review highlights the need to organise well-designed trials to decide the best management strategy for chronic methicillin-sensitive Staphylococcus aureus infection in people with cystic fibrosis.

Authors' conclusions: 

No randomised controlled trials were identified which met the inclusion criteria for this review. Although methicillin-sensitive Staphylococcus aureus is an important and common cause of lung infection in people with cystic fibrosis, there is no agreement on how best to treat long-term infection. The review highlights the need to organise well-designed trials that can provide evidence to support the best management strategy for chronic methicillin-sensitive Staphylococcus aureus infection in people with cystic fibrosis.

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Background: 

Cystic fibrosis is an inherited life-threatening multisystem disorder with lung disease characterized by abnormally thick airway secretions and persistent bacterial infection. Chronic, progressive lung disease is the most important cause of morbidity and mortality in the condition and is therefore the main focus of clinical care and research. Staphylococcus aureus is a major cause of chest infection in people with cystic fibrosis. Early onset, as well as chronic, lung infection with this organism in young children and adults results in worsening lung function, poorer nutrition and increases the airway inflammatory response, thus leading to a poor overall clinical outcome. There are currently no evidence-based guidelines for chronic suppressive therapy for Staphylococcus aureus infection in cystic fibrosis such as those used for Pseudomonas aeruginosa infection.

Objectives: 

To assess the evidence regarding the effectiveness of long-term antibiotic treatment regimens for chronic infection with methicillin-sensitive Staphylococcus aureus (MSSA) infection in people with cystic fibrosis and to determine whether this leads to improved clinical and microbiological outcomes.

Search strategy: 

Trials were identified by searching the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, MEDLINE, Embase, handsearching article reference lists and through contact with local and international experts in the field. We also searched ongoing trials databases.

Date of the last search of the Group's Cystic Fibrosis Trials Register: 03 March 2016.

Selection criteria: 

Randomised or quasi-randomised controlled trials comparing any combinations of topical, inhaled, oral or intravenous antimicrobials used as suppressive therapy for chronic infection with methicillin-sensitive Staphylococcus aureus compared with placebo or no treatment.

Data collection and analysis: 

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

Main results: 

The searches identified 55 trials, but none were eligible for inclusion in the current version of this review.

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