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Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis

Smyth, Alan R; Lo, David K.H.; Muhlebach, Marianne S.

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Authors

Alan R Smyth

David K.H. Lo

Marianne S. Muhlebach



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 not only as an important infection in people who are hospitalised, but also as a potentially harmful pathogen in cystic fibrosis. Chronic pulmonary infection with MRSA is thought to confer on people with cystic fibrosis a worse clinical outcome and result in an increased rate of lung function decline. Clear guidance for MRSA eradication in cystic fibrosis, supported by robust evidence, is urgently needed. This is an update of a previous review.

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. To ascertain whether attempts at eradicating MRSA can lead to increased acquisition of other resistant organisms (including Pseudomonas aeruginosa), increased adverse effects from drugs, or both.

Search methods
We identified randomised and quasi‐randomised controlled trials by searching the Cochrane Cystic Fibrosis and Genetic Disorders (CFGD) Group's Cystic Fibrosis Trials Register, PubMed, MEDLINE and three clinical trials registries; by handsearching article reference lists; and through contact with experts in the field. We last searched the CFGD Group's Cystic Fibrosis Trials Register on 4 October 2021, and the ongoing trials registries on 31 January 2022.

Selection criteria
Randomised controlled trials (RCTs) or quasi‐RCTs of any combinations of topical, inhaled, oral or intravenous antimicrobials primarily aimed at eradicating MRSA compared with placebo, standard treatment or no treatment.

Data collection and analysis
We used standard methodological procedures expected by Cochrane and used the GRADE methodology to assess the certainty of the evidence.

Main results
The review includes three RCTs with 135 participants with MRSA infection. Two trials compared active treatment versus observation only and one trial compared active treatment with placebo.

Citation

Smyth, A. R., Lo, D. K., & Muhlebach, M. S. (2022). Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis. Cochrane Database of Systematic Reviews, 2022(12), Article CD009650. https://doi.org/10.1002/14651858.cd009650.pub5

Journal Article Type Review
Acceptance Date Dec 13, 2022
Online Publication Date Dec 13, 2022
Publication Date Dec 13, 2022
Deposit Date Feb 15, 2016
Publicly Available Date Dec 14, 2023
Journal Cochrane Database of Systematic Reviews
Electronic ISSN 1469-493X
Publisher Cochrane Collaboration
Peer Reviewed Peer Reviewed
Volume 2022
Issue 12
Article Number CD009650
DOI https://doi.org/10.1002/14651858.cd009650.pub5
Keywords Methicillin-Resistant Staphylococcus aureus, Cystic Fibrosis, Staphylococcal Infections, Anti-Bacterial Agents, Pseudomonas aeruginosa, Rifampin
Public URL https://nottingham-repository.worktribe.com/output/744531
Publisher URL https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009650.pub5/full
Additional Information Lo DKH, Muhlebach MS, Smyth AR. Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2022, Issue 12. Art. No.: CD009650. DOI: 10.1002/14651858.CD009650.pub5.

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Copyright Statement
Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.





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