Utilization of antibiotics for methicillin-resistant Staphylococcus aureus infection in cystic fibrosis

Jeffery T. Zobell, Kevin L. Epps, David C. Young, Madison Montague, Jared Olson, Krow Ampofo, Melissa J. Chin, Bruce C. Marshall, Elliott Dasenbrook

Research output: Contribution to journalArticlepeer-review

Abstract

Summary Objectives The purpose of this study was to characterize the utilization of antibiotics for chronic methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients with acute pulmonary exacerbations (PEx). Methods An anonymous national cross-sectional survey of CF Foundation accredited care programs was performed using an electronic survey tool. Results Fifty-eight percent (152/261) CF Foundation accredited programs completed the survey. Ninety-eight percent (149/152) of respondents reported using antibiotics (oral or intravenous) against MRSA. Variability exists in the use of antibiotics amongst the programs and in the dosages utilized. For oral outpatient treatment, sulfamethoxazole/trimethoprim was the most commonly utilized antibiotic by both pediatric (109/287, 38%) and adult (99/295, 34%) respondents, of which, ten percent of reported to use it in combination with rifampin. For inpatient treatment, linezolid (both intravenous (IV) and oral) was most commonly utilized in both pediatric (IV 35/224, 16%; oral 41/224, 18%), and adult (IV 44/235, 19%; oral 38/235, 16%) respondents for inpatient treatment. IV vancomycin was the second most commonly utilized antibiotic by pediatric (70/224, 31%) and adult (71/235, 30%) respondents. Most respondents reported dose titration to achieve a vancomycin trough level of 15-20 mg/L (150/179, 84%). Topical or inhaled antibiotic utilization was reported to be an uncommon practice with approximately 70% of pediatric and adult respondents reporting to use them either rarely or never. The concomitant use of anti-MRSA and anti-pseudomonal antibiotics was common with 96% of pediatric and 99% of adult respondents answering in the affirmative. Conclusion We conclude that anti-MRSA antibiotics are utilized via various dosage regimens by a majority of CF Foundation accredited care programs for the treatment of chronic MRSA in PEx, and there is no consensus on the best treatment approach. Pediatr Pulmonol. 2015; 50:552-559.

Original languageEnglish (US)
Pages (from-to)552-559
Number of pages8
JournalPediatric pulmonology
Volume50
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Keywords

  • Anti-staphylococcal antibiotics
  • Infections
  • MRSA

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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