Abstract

Staphylococcus aureus is a ubiquitous human commensal pathogen. It is commonly isolated in cystic fibrosis (CF) patients and is considered one of the main causes of the recurrent acute pulmonary infections and progressive decline in lung function that characterize this inherited life-threatening multisystem disorder. However, the true role of S. aureus in CF patients is not completely understood. The main aim of this narrative review is to discuss the present knowledge of the role of S. aureus in CF patients. Literature review showed that despite the fact that the availability and use of drugs effective against S. aureus have coincided with a significant improvement in the prognosis of lung disease in CF patients, clearly evidencing the importance of S. aureus therapy, how to use old and new drugs to obtain the maximal effectiveness has not been precisely defined. The most important problem remains that the high frequency with which S. aureus is carried in healthy subjects prevents the differentiation of simple colonization from infection. Moreover, although experts recommend antibiotic administration in CF patients with symptoms and in those with persistent detection of S. aureus, the best antibiotic approach has not been defined. All these problems are complicated by the evidence that the most effective antibiotic against methicillin-resistant S. aureus (MRSA) cannot be used in patients with CF with the same schedules used in patients without CF. Further studies are needed to solve these problems and to assure CF patients the highest level of care.

Highlights

  • Staphylococcus aureus is a ubiquitous human commensal pathogen

  • There is general agreement that antibiotics must be administered to treat acute S. aureus infections (Akil and Muhlebach, 2018), it is not known which kind of therapy is the most effective to reduce the risk of chronic S. aureus disease, when methicillin-resistant S. aureus (MRSA) strains are the causative agents (Muhlebach, 2017)

  • Esposito et al (Esposito et al, 2014) studied 497 healthy subjects aged 6–17 years and found that 264 (53.1%) were S. aureus carriers: 129 (25.9%) oropharyngeal carriers and 195 (39.2%) nasal carriers, of whom 60 (12.1%) were both oropharyngeal and nasal carriers. All these findings suggest that the likeliness of a nasal or oropharyngeal swab being positive for S. aureus accurately reflecting the etiology of a lower respiratory tract infection is poor and that the use of nasal/oropharyngeal swabs to identify S. aureus lung infections can lead to incorrect results with significant overestimation

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Summary

Frontiers in Pharmacology

Staphylococcus aureus is a ubiquitous human commensal pathogen It is commonly isolated in cystic fibrosis (CF) patients and is considered one of the main causes of the recurrent acute pulmonary infections and progressive decline in lung function that characterize this inherited life-threatening multisystem disorder. Experts recommend antibiotic administration in CF patients with symptoms and in those with persistent detection of S. aureus, the best antibiotic approach has not been defined. All these problems are complicated by the evidence that the most effective antibiotic against methicillin-resistant S. aureus (MRSA) cannot be used in patients with CF with the same schedules used in patients without CF.

INTRODUCTION
CARRIAGE OF STAPHYLOCOCCUS AUREUS IN HEALTHY SUBJECTS AND IN CF PATIENTS
PROPHYLAXIS OF STAPHYLOCOCCUS AUREUS COLONIZATION
STAPHYLOCOCCUS AUREUS INFECTION IN CF PATIENTS
FACTORS ASSOCIATED WITH THE PERSISTENCE OF STAPHYLOCOCCUS AUREUS IN CF PATIENTS
TREATMENT OF ACUTE AND CHRONIC STAPHYLOCOCCUS AUREUS INFECTION IN CF PATIENTS
CONCLUSIONS
Findings
AUTHOR CONTRIBUTIONS
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