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MRSA findings


I have been MRSA positive since 2010 but it is not harmful in my case. After two eradication attempts with Vancomycin (oral) which did not show any effect the bacteria has not been treated anymore.

I never had an i.v., and swabs of skin and nose were never taken in my CF center either; the findings were only confirmed by sputum samples.

Due to an ambulant operation in another hospital this was done subsequently: nose and skin were negative, only in the throat MRSA was detected.

I bought Octenidol® (Octenidine dihydrochloride) immediately and have been gargling regurlarly.

Where is the germ located most likely…? In the throat and therefore the sputum samples are contaminated? Or is it rather located in the lung and the germ comes to the throat by coughing up sputum?

Is it possible that a professional dental cleaning would help? I would like to go to a rehabilitation center very much.

Dear questioner,

MRSA is detected in 3 to 5% of all CF patients. As in your case, the germ frequently does not cause an acute infection, however it stays chronically with the patient, in many cases in the airways, in rarer cases on the skin. Shortly after the first evidence, a therapy (eracation therapy, i.e. germ elimination therapy) attempt should be made, in case of acute infections this should be tried several times.

Regardless of where [throat, skin…] the MRSA was detected the patient is called MRSA-positive. In an out-patient setting (ambulant) it is not necessary to repeat all swabs with each check-up. If patients are admitted for in-patient treatment or before a surgery though, usually, all test are performed. In CF patients this means swabs of nose, throat, skin, perianal area (around the anus) and sputum test. If there are signs that a patient being MRSA-positive so far might have lost the germ, then the negative findings have to be confirmed three times with all swabs and sputum test. Only if all three series are negative concerning MRSA the patient can be called MRSA-negative. In this case he/she can do a rehabilitation program in a rehabilitation center.
If MRSA is only detected in the nose this can be treated with Mupirocin ointment (Turixin®).
If MRSA is only detected in the throat a therapy attempt with e.g. Octenidol® mouth wash(Octenidine dihydrochloride) can be done.
If MRSA is detected on the skin, elimination can be attempted by using, e.g., Octenisept® (Octenidin + 2-Phenoxyethanol) solution for washing.
This can also be done prophylactically if MRSA was found in other places.
If MRSA is detected in the sputum, such local therapy is ineffective and therefore only the administration of antibiotics systemically (tablets or intravenously) can be done. Systemical therapy can also be done if local therapy was not successful.
The CF doctor in charge decides if such a therapy is indicated. Usually, Vancomycin is suitable for systemic therapy against MRSA but only if administered intravenously. Orally (tablets), Vancomycin is only effective against certain intestinal infections. For other infections this antibiotic is not effective if administered orally since it is not sufficiently resorbed from the gastrointestinal tract.

So, in your case no effective therapy attempt against MRSA has been done so far. Please talk with your CF doctor about a Vancomycin therapy administered intravenously, or, if indicated, about the treatment with Zyvoxid® (Linezolid), orally or intravenously. Possibly, one of those two antibiotics could be successful.

If MRSA is detected in the throat and in the sputum it cannot be said clearly where the germ appeared primarily since expansion/contamination is possible in both ways (from throat to the lower airways or vice-versa).

A professional dental cleaning from time to time is surely helpful with regard to the general mouth hygiene but it is too optimistic to expect that MRSA colonization could be eliminated this way.
While it is fully understandable that you wish to go to a rehabilitation center we do - unfortunately - not know a rehabilitation center [clinic] that is accepting CF patients with MRSA. [the original question and answer was asked in the German expert advice; so, this information is valid for Germany only]. However, please contact the Mukoviszidose e.V. [German patient organization] to check the possibility if a so called "Klimakur" [German word for a special treatment in a favorable climate] would be possible on as an individual measure.

All the best,
Dr. Christina Smaczny