Use of quinupristin/dalfopristin in a critical patient with a methicillin-resistant Staphilococcus aureus infection

• Published in: Minerva anestesiologica Vol. 70; no. 10; pp. 747 - 9; 749-51
• Main Authors: De Robertis, E, Viscidi, D, Servillo, G, Pezza, M, Piazza, O, Giuliano, C A, Tufano, R
• Format: Journal Article
• Language: English; Italian
• Published: Italy 01.10.2004
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Critical Illness; Humans; Male; Methicillin Resistance; Staphylococcal Infections - drug therapy; Staphylococcal Infections - etiology; Staphylococcal Infections - microbiology; Thoracic Injuries - complications; Thoracic Injuries - diagnostic imaging; Tomography, X-Ray Computed; Virginiamycin - analogs & derivatives; Virginiamycin - therapeutic use; Wounds, Stab - complications; Wounds, Stab - diagnostic imaging
• ISSN: 0375-9393; 1827-1596

The growing incidence of infections due to Gram-positive multiresistant germs has stimulated research into new drugs endowed with broader activity, that are useful in case of infections unresponsive to common antibiotics. The case of a 28-year-old man infected with a methicillin resistant Staphylococcus aureus non responder to therapy with glycopeptide antibiotics is reported. At admission the patient presented a septic condition and required mechanical ventilation. Antibiotic therapy was immediately started with teicoplanin+meropenem. Blood culture and bronchial aspirate evidenced a methicillin resistant Staphylococcus aureus with high sensibility to glycopeptide antibiotics. Although this therapy produced a slight improvement in clinical condition and the patient was extubated, fever and leucocytosis associated with a BAL positive to methicillin resistant Staphylococcus aureus, in vitro susceptible to glycopeptides, persisted. Considering the possibility of a non-responder condition of the patient to glycopeptide antibiotics, quinupristin/dalfopristin was added. The streptogramin produced a quick improvement in clinical condition with resolution of sepsis and culture sterilization. The patient improved progressively and was discharged. In conclusion, in our experience the association quinupristin/dalfopristin was effective in the resolution of a critical methicillin resistant Staphylococcus aureus infection non responder to classical treatment with glycopeptide antibiotics that showed a high sensibility in vitro.