Sonya L Heltshe1, Lisa Saiman2, Elena B Popowitch3, Melissa B Miller3, Margaret Kloster4, Valeria Thompson4, Thomas W Ferkol5, Wynton C Hoover6, Michael S Schechter7, Marianne S Muhlebach8. 1. Division of Pediatric Pulmonology, Department of Pediatrics , University of Washington School of Medicine , Seattle ; Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center , Seattle Children's Research Institute , Washington. 2. Department of Pediatrics, Columbia University Medical Center , New York ; Department of Infection Prevention & Control , New York-Presbyterian Hospital. 3. Department of Medicine and ; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill. 4. Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center , Seattle Children's Research Institute , Washington. 5. Department of Pediatrics ; Department of Genetics, Washington University, St. Louis, Missouri. 6. Department of Pediatrics , University of Alabama at Birmingham. 7. Emory University School of Medicine , Atlanta, Georgia. 8. Division of Pediatric Pulmonology, Department of Pediatrics , University of North Carolina at Chapel Hill.
Abstract
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infects ∼25% of patients with cystic fibrosis (CF) in the United States. We hypothesized that health-related outcomes differed between healthcare-associated (staphylococcal cassette chromosome mec [SCCmec] II) vs community-associated (SCCmec IV) MRSA strains in patients chronically infected with CF. METHODS: At 7 CF centers, MRSA isolates were prospectively obtained from patients ≤18 years old with 2 or more positive MRSA cultures within 1 year. Isolates were classified by SCCmec type and Panton-Valentine-leukocidin (PVL) status at a core laboratory, and sites remained blinded to SCCmec type and PVL results. Prospective clinical data including antibiotic use, respiratory symptoms, and pulmonary exacerbations were obtained. RESULTS: Among the 295 cohort participants with typeable MRSA isolates, 69.5% had SCCmec II PVL(-), 13.2% had SCCmec IV PVL(-), and 17.3% had SCCmec IV PVL(+) strains. During follow-up of 287 patients with prospective data after enrollment, the risk for pulmonary exacerbations was significantly higher among participants with SCCmec II than SCCmec IV strains (risk ratio [RR] = 1.13; P = .03) and higher in those with SCCmec IV PVL(-) than SCCmec IV PVL(+) strains (RR = 1.62; P < .0001). Neither decline in lung function nor changes in nutritional outcomes differed by SCCmec type or PVL status during the study period. CONCLUSIONS: Participants harboring chronic SCCmec II MRSA received more antibiotics and may have more lung disease than those with SCCmec IV; PVL(+) isolates were not associated with more advanced disease.
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infects ∼25% of patients with cystic fibrosis (CF) in the United States. We hypothesized that health-related outcomes differed between healthcare-associated (staphylococcal cassette chromosome mec [SCCmec] II) vs community-associated (SCCmec IV) MRSA strains in patients chronically infected with CF. METHODS: At 7 CF centers, MRSA isolates were prospectively obtained from patients ≤18 years old with 2 or more positive MRSA cultures within 1 year. Isolates were classified by SCCmec type and Panton-Valentine-leukocidin (PVL) status at a core laboratory, and sites remained blinded to SCCmec type and PVL results. Prospective clinical data including antibiotic use, respiratory symptoms, and pulmonary exacerbations were obtained. RESULTS: Among the 295 cohort participants with typeable MRSA isolates, 69.5% had SCCmec II PVL(-), 13.2% had SCCmec IV PVL(-), and 17.3% had SCCmec IV PVL(+) strains. During follow-up of 287 patients with prospective data after enrollment, the risk for pulmonary exacerbations was significantly higher among participants with SCCmec II than SCCmec IV strains (risk ratio [RR] = 1.13; P = .03) and higher in those with SCCmec IV PVL(-) than SCCmec IV PVL(+) strains (RR = 1.62; P < .0001). Neither decline in lung function nor changes in nutritional outcomes differed by SCCmec type or PVL status during the study period. CONCLUSIONS:Participants harboring chronic SCCmec II MRSA received more antibiotics and may have more lung disease than those with SCCmec IV; PVL(+) isolates were not associated with more advanced disease.
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