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Jones AM. Infection control in cystic fibrosis: evolving perspectives and challenges. Curr Opin Pulm Med 2022; 28:571-576. [PMID: 36101908 DOI: 10.1097/mcp.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews the impact of some of the most recent changes in clinical care management in cystic fibrosis on infection prevention practice and advice for people with cystic fibrosis. RECENT FINDINGS People with cystic fibrosis (CF) consistently highlight infection control as one of their major concerns. Infection prevention guidance and practice has facilitated successful decreases in rates of many transmissible CF pathogens. The coronavirus disease 2019 pandemic highlighted the clinical significance of respiratory viral infections and has accelerated the implementation of remote monitoring and telemedicine consultations as standard practice in CF. The continued improvement in health of the CF population is being further augmented by the introduction of new therapies, in particular cystic fibrosis transmembrane conductance regulator modulators. Infection prevention will remain pertinent to CF care, but these recent changes in clinical practice will have ongoing implications for infection prevention guidance in CF. SUMMARY Recent changes in CF clinical care have implications that will lead to further evolution of infection control practice and advice.
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Chalmers SJ, Wylam ME. Methicillin-Resistant Staphylococcus aureus Infection and Treatment Options. Methods Mol Biol 2020; 2069:229-251. [PMID: 31523777 DOI: 10.1007/978-1-4939-9849-4_16] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of infection worldwide, including a wide array of both hospital- and community-acquired infections-most commonly bacteremia, upper and lower respiratory tract infection, skin and soft-tissue infection, osteomyelitis, and septic arthritis. This chapter describes the epidemiology of MRSA infection, its ability to confer antibiotic resistance and produce a wide array of virulence factors, and its pivotal role in human infection, especially cystic fibrosis. It also provides an introduction to the strategies for treatment of both chronic and acute MRSA infections.
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Affiliation(s)
- Sarah J Chalmers
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Mark E Wylam
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Intermittent colonisation with Methicillin-Resistant Staphylococcal aureus can be eradicated from the Airways of Adults with Cystic Fibrosis. Antibiotics (Basel) 2019; 8:antibiotics8030113. [PMID: 31405052 PMCID: PMC6783918 DOI: 10.3390/antibiotics8030113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/05/2022] Open
Abstract
The airways of people with cystic fibrosis (CF) are chronically colonised with different pathogens. With recent interest in methicillin-resistant Staphylococcusaureus (MRSA), we have recently examined the rates of MRSA colonisation in different groups within our CF Service. This paper now examines the effectiveness of eradication strategies to clear the MRSA colonisation.
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Song Y, Keatley LR, Middleton PG. Methicillin-resistant Staphylococcus aureus in health-care workers with cystic fibrosis in Sydney. Respirol Case Rep 2018; 6:e00378. [PMID: 30397479 PMCID: PMC6204757 DOI: 10.1002/rcr2.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
Cystic Fibrosis (CF), the most common lethal inherited disorder in Australia, is associated with increased respiratory tract colonization/infection. Given that many adults with CF work as health-care workers (HCW), which has been associated with an increased risk of methicillin-resistant Staphylococcus aureus (MRSA) colonization/infection, we examined these risks in 252 adults with CF at our centre between 2001-2015. Demographic and clinical characteristics, including pathogens, were compared for HCW and non-HCW groups. MRSA colonization/infection was found in 20 subjects, comprising 2/19 HCW, and 18/233 non-HCW (p = 0.66). Sixteen of these 20 subjects undertook eradication therapy, with success in 2/2 HCW and 5/14 non-HCW. This study showed that the rate of MRSA colonization/infection did not differ between adults with CF who work in the health-care setting versus other areas. This suggests that choosing a health-care profession does not necessarily result in an increased risk of MRSA colonization/infection for an adult with CF.
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Affiliation(s)
- Yang Song
- Cystic Fibrosis Service, Department of Respiratory and Sleep MedicineWestmead HospitalAustralia
- Cystic Fibrosis UnitLudwig Engel Centre for Respiratory Research, Westmead Institute for Medical ResearchUniversity of SydneyAustralia
| | - Lucy Rebecca Keatley
- Cystic Fibrosis Service, Department of Respiratory and Sleep MedicineWestmead HospitalAustralia
| | - Peter Gordon Middleton
- Cystic Fibrosis Service, Department of Respiratory and Sleep MedicineWestmead HospitalAustralia
- Cystic Fibrosis UnitLudwig Engel Centre for Respiratory Research, Westmead Institute for Medical ResearchUniversity of SydneyAustralia
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Akil N, Muhlebach MS. Biology and management of methicillin resistant Staphylococcus aureus in cystic fibrosis. Pediatr Pulmonol 2018; 53:S64-S74. [PMID: 30073802 DOI: 10.1002/ppul.24139] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus is one of the earliest bacteria isolated from the respiratory tract in people with cystic fibrosis (CF). Its methicillin resistant form, MRSA, has gained attention due to the rapid increase in the last decades and worse outcomes with chronic infection. In the United States, prevalence of MRSA in CF is around 27%, but is much lower (3-18%) in most other countries. Methicillin is typically genetically encoded by the mecA gene, which encodes for an alternative penicillin binding protein (PRBa). This PRBa has low affinity to β-lactams, thereby enabling growth of S. aureus in the presence of penicillinase resistant penicillins and most other β-lactams. Non-mecA positive strains of MRSA, so-called borderline resistant (BORSA) have also been described. In addition to production of toxins, the virulence of S. aureus is conferred by its adaptability allowing persistence in face of antibiotic therapies and host defense. These adaptive growth mechanisms include small colony variants, biofilms, and growth under anaerobic conditions. Several reports have described successful eradication of MRSA, yet only two randomized trials of eradication during early infection have been conducted. A list of MRSA specific antibiotics with dosing relevant to CF patients is presented here. Many of these require special dosing in people with CF. Novel antibiotics are in trials for skin and soft tissue infections and it is unclear if and when those might be available for lung infections. Thus the best strategies for MRSA would be primary prevention.
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Affiliation(s)
- Nour Akil
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina
| | - Marianne S Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of NC at Chapel Hill, Chapel Hill, North Carolina.,Marisco Lung Institute, University of NC at Chapel Hill, Chapel Hill, North Carolina
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Bell SC, Armstrong D, Harrington G, Jardine L, Divakaran R, Loff B, Middleton PG, McDonald T, Rowland K, Wishart M, Wood ME, Stuart RL. Work environment risks for health care workers with cystic fibrosis. Respirology 2018; 23:1190-1197. [PMID: 30215873 DOI: 10.1111/resp.13404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/22/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
Abstract
In Australia and New Zealand, >50% of people with cystic fibrosis (CF) are adults and many of these people are pursuing vocational training and undertaking paid employment. More than 6% of adults with CF are working in health care. There is limited guidance in literature to support health care workers with CF (HCWcf) in training and in employment to support safe practice and to provide protection for themselves and their patients from the acquisition of health care associated infection. A multidisciplinary team of CF and Infectious Disease Clinicians, Infection Prevention and Control Practitioners, HCWcf, academic experts in medical ethics and representatives from universities, appraised the available evidence on the risk posed to and by HCWcf. Specific recommendations were made for HCWcf, CF health care teams, hospitals and universities to support the safe practice and appropriate support for HCWcf.
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Affiliation(s)
- Scott C Bell
- Department of Thoracic Medicine, Adult Cystic Fibrosis Centre, The Prince Charles Hospital and QIMR Berghofer Medicine Research Institute, Brisbane, QLD, Australia
| | - David Armstrong
- Monash Children's Cystic Fibrosis Centre, Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | | | - Luke Jardine
- Department of Neonatology, Mater Mothers' Hospital, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Bebe Loff
- Michael Kirby Centre for Public Health and Human Rights, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter G Middleton
- Department Respiratory and Sleep Medicine, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Tim McDonald
- Department of Paediatrics, Canberra Hospital, Canberra, ACT, Australia
| | - Karen Rowland
- Department of Infectious Disease, Calvary Hospital, Adelaide, SA, Australia
| | - Michael Wishart
- Department of Infection Control and Prevention, Holy Spirit Northside, Brisbane, QLD, Australia
| | - Michelle E Wood
- Department of Physiotherapy and Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rhonda L Stuart
- Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
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Savant AP, McColley SA. Cystic fibrosis year in review 2016. Pediatr Pulmonol 2017; 52:1092-1102. [PMID: 28608632 DOI: 10.1002/ppul.23747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022]
Abstract
In this article, we highlight cystic fibrosis (CF) research and case reports published in Pediatric Pulmonology during 2016. We also include articles from a variety of journals that are thematically related to these articles, or are of special interest to clinicians.
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Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Resear ch Institute, Chicago, Illinois
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