METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS - IMPACT AT A NATIONAL CYSTIC-FIBROSIS CENTER

In many patient populations there has been a progressive increase in t he prevalence of methicillin-resistant Staphylococcus aureus (MRSA). W e examined the prevalence and consequences of acquiring MRSA in the ad ult cystic fibrosis (CI;) population at Royal Brompton. Patients who b ecame colonized by MRSA between 1965 and 1997 were identified from an existing database and case-notes were reviewed. Clinical and microbiol ogical data were recorded. Twenty-six patients became colonized with M RSA during this period. Median age at acquisition was 23.4 years (rang e 11.8-43.3 years) and median FEV1 (percent predicted) was 28.9% (rang e 12-81%). Twenty patients (77%) had an FEV1 of less than or equal to 40% predicted. MRSA was probably acquired by four patients at Royal Br ompton. In 17 patients isolates were first identified whilst under the care of a total of 11 other institutions. Since the first case of MRS A infection in 1982, there has been an increase in prevalence to a cur rent rate of nine cases in the first seven months of 1997. The commone st site of colonization was the lower airway (96%); the nose (23%) and skin sites (15%) were more rarely affected. Duration of colonization was frequently brief with nine cases (35%) lasting less than one month . The identification of MRSA appeared to be of little clinical signifi cance, and did not generally affect outcomes. Only three patients were MRSA positive at the time of death, and in only one of these was MRSA considered a possible contributing factor.