COMPLICATED PNEUMONIA IN A PATIENT WITH CYSTIC FIBROSIS AND METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS INFECTION

Abstract

Cystic fibrosis (CF) is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, resulting in characteristic features of CF, including chronic airway infection and inflammation, airways damage, and progressive lung disease [1]. CF patients experience alterations in their microbiome, which contribute to the development of chronic bacterial lung infections, leading to excessive lung inflammation and impair airway epithelial barrier function [2-3]. Staphylococcus aureus (SA) is considered one of the main causes of the recurrent acute pulmonary infections and progressive lung function decline in patients with CF [4]. Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in CF patients and is typically associated with complications. Despite antibiotic treatment, these infections often become chronic. MRSA is linked to an increased frequency of annual pulmonary exacerbations and a higher rate of hospitalization. We present the case of a 17-year-old female patient, diagnosed with CF since the age of 12, who presented to the emergency room due to dyspnea and worsening chronic respiratory failure, accompanied by a productive cough and greenish sputum. Sputum culture revealed multidrug-resistant SA. Initially, the patient’s clinical course was unfavorable, resulting in the development of a right pneumothorax after a coughing episode. However, with appropriate surgical treatment and antibiotic therapy guided by antimicrobial susceptibility testing (AST), the patient’s condition subsequently improved. When MRSA is detected, it should be promptly eradicated [5]. However, despite the introduction of new antibiotics, there is a lack of consensus regarding the optimal choice of antibiotics, dosing, and duration of treatment. Pneumothorax is a potentially life-threatening complication that can arise in both MRSA lung infections and CF patients. As a result, managing MRSA infections in CF patients continues to pose significant challenges.