Rifampicin and sodium fusidate reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) isolation in adults with cystic fibrosis and chronic MRSA infection

Nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) to patients with cystic fibrosis (CF) frequently results in chronic respiratory tract carriage. This is an increasing problem, adds to the burden of glycopeptide antibiotic use in hospitals, and represents a relative contraindication to lung transplantation. The aim of this study was to determine whether it is possible to eradicate MRSA with prolonged oral combination antibiotics, and whether this treatment is associated with improved clinical status. Adult CF patients (six male, one female) with chronic MRSA infection were treated for six months with rifampicin and sodium fusidate. Outcome data were examined for six months before treatment, on treatment and after treatment. The patients had a mean age of 29.3 (standard deviation=6.3) years and FEV(1) of 36.1% (standard deviation=12.7) predicted. The mean duration of MRSA isolation was 31 months. MRSA isolates identified in these patients was of the same lineage as the known endemic strain at the hospital when assessed by pulsed-field gel electrophoresis. Five of the seven had no evidence of MRSA during and for at least six months after rifampicin and sodium fusidate. The proportion of sputum samples positive for MRSA was lower during the six months of treatment (0.13) and after treatment (0.19) compared with before treatment (0.85) (P<0.0001). There was a reduction in the number of days of intravenous antibiotics per six months with 20.3+/-17.6 on treatment compared with 50.7 before treatment and 33.0 after treatment (P=0.02). There was no change in lung function. Gastrointestinal side effects occurred in three, but led to therapy cessation in only one patient. Despite the use of antibiotics with anti-staphylococcal activity for treatment of respiratory exacerbation, MRSA infection persists. MRSA can be eradicated from the sputum of patients with CF and chronic MRSA carriage by using rifampicin and sodium fusidate for six months. This finding was associated with a significant reduction in the duration of intravenous antibiotic treatment during therapy.

Antibiotic Management of Lung Infections in Cystic Fibrosis. I. The Microbiome, Methicillin-Resistant Staphylococcus aureus, Gram-Negative Bacteria, and Multiple Infections

Despite significant advances in treatment strategies targeting the underlying defect in cystic fibrosis (CF), airway infection remains an important cause of lung disease. In this two-part series, we review recent evidence related to the complexity of CF airway infection, explore data suggesting the relevance of individual microbial species, and discuss current and future treatment options. In Part I, the evidence with respect to the spectrum of bacteria present in the CF airway, known as the lung microbiome is discussed. Subsequently, the current approach to treat methicillin-resistant Staphylococcus aureus, gram-negative bacteria, as well as multiple coinfections is reviewed. Newer molecular techniques have demonstrated that the airway microbiome consists of a large number of microbes, and the balance between microbes, rather than the mere presence of a single species, may be relevant for disease pathophysiology. A better understanding of this complex environment could help define optimal treatment regimens that target pathogens without affecting others. Although relevance of these organisms is unclear, the pathologic consequences of methicillin-resistant S. aureus infection in patients with CF have been recently determined. New strategies for eradication and treatment of both acute and chronic infections are discussed. Pseudomonas aeruginosa plays a prominent role in CF lung disease, butmany other nonfermenting gram-negative bacteria are also found in the CF airway. Many new inhaled antibiotics specifically targeting P. aeruginosa have become available with the hope that they will improve the quality of life for patients. Part I concludes with a discussion of how best to treat patients with multiple coinfections.

Microstructural evolution and mechanical properties of short-term thermally exposed 9/12Cr heat-resistant steels

The microstructural evolution during short-term (up to 3000 hours) thermal exposure of three 9/12Cr heat-resistant steels was studied, as well as the mechanical properties after exposure. The tempered martensitic lath structure, as well as the precipitation of carbide and MX type carbonitrides in the steel matrix, was stable after 3000 hours of exposure at 873 K (600 °C). A microstructure observation showed that during the short-term thermal exposure process, the change of mechanical properties was caused mainly by the formation and growth of Laves-phase precipitates in the steels. On thermal exposure, with an increase of cobalt and tungsten contents, cobalt could promote the segregation of tungsten along the martensite lath to form Laves phase, and a large size and high density of Laves-phase precipitates along the grain boundaries could lead to the brittle intergranular fracture of the steels.

The impact toughness of a nitride-strengthened martensitic heat resistant steel

The nitride-strengthened martensitic heat resistant steel is precipitation strengthened only by nitrides. In the present work, the effect of nitride precipitation behavior on the impact toughness of an experimental steel was investigated. Nitrides could hardly be observed when the steel was tempered at 650°C. When the tempering temperature was increased to 700°C and 750°C, a large amount of nitrides were observed in the matrix. It was surprising to reveal that the impact energy of the half-size samples greatly increased from several Joules to nearly a hundred Joules. The ductile-brittle transition temperature (DBTT) was also discovered to decrease from room temperature to −50°C when the tempering temperature was increased from 650°C to 750°C. The nitride precipitation with increasing tempering temperature was revealed to be responsible for the improved impact toughness.