Published ahead of print on July 31, 2008, doi:10.1164/rccm.200802-327OC Am. J. Respir. Crit. Care Med., Volume 178, Number 8, October 2008, 814-821 A more recent version of this article appeared on October 15, 2008
Submitted on February 24, 2008 Persistent Methicillin-resistant Staphylococcus Aureus and Rate of FEV1 Decline in Cystic FibrosisElliott C Dasenbrook1*,1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2 Departments of Biostatistics and Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA * To whom correspondence should be addressed. E-mail: edasenb1{at}jhmi.edu.
Rationale: The prevalence in cystic fibrosis (CF) of respiratory cultures with methicillin-resistant Staphylococcus aureus (MRSA) has dramatically increased over the last ten years, but the effect of MRSA on FEV1 decline in CF is unknown.
Objective: To determine the association between MRSA respiratory infection and FEV1 decline in children and adults with CF.
Methods: Ten-year cohort study using the CF Foundation patient registry from 1996-2005. We studied individuals who developed new MRSA respiratory tract infection. Repeated measures regression was used to assess the association between MRSA and FEV1 decline, adjusted for confounders, in individuals aged 8-21 and adults (aged 22-45). Two different statistical models were used to assess robustness of results.
Measurements and Main Results: The study cohort included 17,357 patients with an average follow-up of 5.3 years. During the study period 1732 individuals developed new persistent MRSA infection ( Key words: Cystic Fibrosis, Methicillin-resistant Staphylococcus Aureus, Longitudinal Studies, Pulmonary Function Test, Epidemiology
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3 MRSA cultures; average 6.8 positive cultures) and were subsequently followed for an average of 3.5 years. Even after adjustment for confounders, rate of FEV1 decline in individuals aged 8-21 with persistent MRSA was more rapid in both statistical models. Their average FEV1 decline of 2.06% predicted/year was 43% more rapid than the 1.44% predicted/year in those without MRSA (difference -0.62% predicted/year, 95% CI -0.70 to -0.54; p<0.001). Effect of MRSA on FEV1 decline in adults was not clinically significant.
Conclusions: Persistent infection with MRSA in individuals with CF between the ages of 8-21 is associated with a more rapid rate of decline in lung function.
