Treatment of life-threatening multiresistant staphylococcal and enterococcal infections in patients with end-stage renal failure with quinupristin/dalfopristin : Preliminary report

• Published in: Infection Vol. 30; no. 5; pp. 257 - 261
• Main Authors: SCHWENGER, V, MÜNDLEIN, E, DAGROSA, E. E, FAHR, A. M, ZEIER, M, MIKUS, G, ANDRASSY, K
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.10.2002; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Bacteremia - diagnosis; Bacteremia - drug therapy; Bacterial diseases; Biological and medical sciences; Critical Illness; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination - pharmacokinetics; Drug Therapy, Combination - therapeutic use; Enterococcus faecium - drug effects; Female; Follow-Up Studies; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - drug therapy; Human bacterial diseases; Humans; Infectious diseases; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - microbiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Methicillin Resistance; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prospective Studies; Renal failure; Risk Assessment; Sampling Studies; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal infections, streptococcal infections, pneumococcal infections; Treatment Outcome; Vancomycin Resistance; Virginiamycin - administration & dosage; Virginiamycin - analogs & derivatives; Virginiamycin - pharmacokinetics; Virginiamycin - therapeutic use; Intravenous administration; Dalfopristin; Multiple resistance; Bacteria; Micrococcales; Micrococcaceae; Staphylococcus aureus; Kidney disease; Human; Drug combination; Urinary system disease; Critically ill; Treatment efficiency; Terminal stage; Quinupristin; Infection; Streptococcaceae; Enterococcus faecium; Antibiotic; Staphylococcus epidermidis; Treatment; Renal failure; Bacteriosis; Streptogramins; Antibacterial agent; Staphylococcal infection
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-002-2076-3

Life-threatening infections with multiresistant gram-positive bacteria are increasing. Treatment with quinupristin/dalfopristin (Q-D) has turned out to be effective against such resistant pathogens. We report on treatment of six patients on dialysis (four with additional liver injury) and of one renal graft recipient with normal renal function who had severe infections caused by multiresistant Staphylococus epidermidis (1/7), methicillin-resistant Staphylococcus aureus (4/7) and vancomycin-resistant Enterococcus faecium (2/7). Six out of seven patients were cured by therapy with Q-D in adjusted doses lasting for 10 to 34 days. Pharmacokinetics of Q-D and its metabolites were determined and remained within the therapeutic range, despite a modest increase of all compounds at the presumed steady state. The concentrations of the metabolites of Q-D were clearly lower than the parent drugs, including those of quinupristin-conjugated derivatives, which has not been reported previously. These preliminary results suggest that: a) neither quinupristin nor dalfopristin or its metabolites accumulated despite the long duration of treatment; b) no adjustment of the standard dosage regimen (three times 7.5 mg/kg/day) is necessary in end-stage renal disease.