Safety of tedizolid as suppressive antimicrobial therapy for patients with complex implant-associated bone and joint infection due to multidrug-resistant Gram-positive pathogens: results from the TediSAT cohort study

Abstract A prospective cohort study was conducted to evaluate long-term safety of tedizolid as suppressive antimicrobial treatment in patients with implant-associated bone and joint infection caused by multidrug-resistant Gram-positive pathogens. Seventeen patients received tedizolid with a median duration of treatment of 6 months No patients developed a serious adverse event.

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Outpatient Parenteral Antimicrobial Treatment (OPAT)

Tutorial Topics in Infection for the Combined Infection Training Programme ◽

10.1093/oso/9780198801740.003.0058 ◽

2019 ◽

Author(s):

Mark Melzer

Keyword(s):

Ambulatory Care ◽

Lower Limb ◽

Care Setting ◽

Joint Infection ◽

Multidrug Resistant ◽

Antimicrobial Treatment ◽

Ambulatory Care Setting ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Receive Treatment ◽

The Uk

Outpatient parenteral antimicrobial therapy (OPAT) is the provision of intravenous (IV) antibiotics to patients in the community or an ambulatory care setting. It was first used to treat children with cystic fibrosis in the 1970s but did not become part of adult services in the UK until the 1990s. OPAT facilitates hospital admission avoidance and decreased lengths of inpatient stay. It is associated with high levels of patient satisfaction. Recent clinical guidelines on the provision of OPAT services in the UK and US have recently been published Skin and soft tissue infections (SSTIs), in particular lower limb cellulitis, are the commonest medical conditions referred to OPAT services. Patients are typically treated for three to five days with IV antibiotics but patients with lymphoedema or underlying skin conditions typically require longer courses. Increasingly, multidrug-resistant urinary tract infections (UTIs) may be treated in the community with IV antibiotics, although oral options such as fosfomycin are now available. Patients with bone and joint infection invariably require prolonged parenteral antibiotic courses, whether this be vertebral osteomyelitis or native or prosthetic joint infection. Other less common examples, where careful patient selection is required, include infected diabetic foot ulcers (with or without osteomyelitis), infective endocarditis, empyema, liver, and tubo-ovarian and brain abscesses. Patients are recruited on the basis of clinical syndromes (e.g. lower limb cellulitis) or laboratory referral (e.g. multidrug-resistant UTIs). Active recruitment (e.g. attendance at acute assessment unit board rounds or orthopaedic multidisciplinary teams, MDTs) compared to passive recruitment (waiting for clinical referrals) increases the yield of patients. The suitability of a patient to receive treatment out of hospital or in an ambulatory care setting needs careful assessment and is dependent upon age, comorbidities, and severity of infection. OPAT also requires patients to engage actively and reliably with therapy. Therefore, IV drug users and patients with serious mental health problems are generally not suitable. Commonly used antibiotics are those given once daily as these reduce nursing time, although some nursing teams can administer IV antibiotics up to three times per day. It is imperative to take a drug allergy history and seek an alternative class of antibiotics when a patient complains of severe penicillin allergy.

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2287. Real-world Use of Tedizolid Phosphate: A Case Series of Long-Term Tolerability

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1965 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S784-S784

Author(s):

Taylor Morrisette ◽

Beatriz Da Silva ◽

Scott W Mueller ◽

Laura Damioli ◽

Martin Krsak ◽

...

Keyword(s):

White Blood Cells ◽

Case Series ◽

Multidrug Resistant ◽

Primary Objective ◽

Term Therapy ◽

Gram Positive ◽

Safe Alternative ◽

Term Tolerability

Abstract Background Tedizolid is an oxazolidinone antibiotic with broad-spectrum Gram-positive activity approved for the treatment of skin and skin structure infections with a 6-day course. Oxazolidinone antibiotics represent appealing options for prolonged antimicrobial therapy due to their available oral formulations with excellent bioavailability and potent in vitro activity against various multidrug-resistant Gram-positive organisms, Mycobacterium spp., and Nocardia spp. Although tedizolid and linezolid offer a similar clinical spectrum based on antimicrobial activity alone, long-term use of linezolid is often limited by serious adverse effects. Preliminary assessments have suggested better tolerability with tedizolid; however, these are limited by shorter exposure duration. The objective of this study was to evaluate the long-term safety and tolerability of tedizolid. Methods Retrospective cohort of adult patients receiving tedizolid for ≥ 28 days, with baseline complete blood cell (CBC) indices available, and CBC indices drawn ≥ 14 days into tedizolid course. The primary objective was to evaluate the long-term tolerability of tedizolid. Results 13 patients met inclusion criteria: median age 61 years (IQR, 51–64 years), 69% male, 85% Caucasian. The majority of patients utilized tedizolid for suppression (85%), and the median duration of tedizolid was 113 days (IQR, 71–204 days). There were no differences in CBC indices when comparing baseline to last laboratory draw throughout tedizolid exposure: platelets (baseline: 203 x 109/L (IQR, 186–283 x 109/L) vs. last: 196 x 109/L (IQR, 161–303 x 109/L; p = 0.65), hemoglobin (baseline: 9.8 g/dL (IQR, 8.8–11.1 g/dL) vs. last: 11.7 g/dL (IQR, 11.0–13.1 g/dL; p = 0.10), and white blood cells (baseline: 6.2 x 109/L (IQR, 5.6–7.6 x 109/L) vs. last: 6.5 x 109/L (IQR, 6.3–7.3 x 109/L; p = 0.45). The final laboratory draws were obtained a median of 78 days (IQR, 44–119 days) into therapy. No patients experienced peripheral neuropathy, optic neuritis/visual changes, or serotonin syndrome during treatment/suppression with tedizolid during the period evaluated. Conclusion Long-term therapy with tedizolid appears to be well-tolerated. Treatment and suppression with tedizolid seems to be a safe alternative to linezolid. Disclosures All authors: No reported disclosures.

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Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients

European Respiratory Journal ◽

10.1183/13993003.00353-2018 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1800353 ◽

Cited By ~ 1

Author(s):

Ian F. Walker ◽

Oumin Shi ◽

Joseph P. Hicks ◽

Helen Elsey ◽

Xiaolin Wei ◽

...

Keyword(s):

Risk Factors ◽

Adverse Event ◽

Treatment Success ◽

Multidrug Resistant ◽

Cox Proportional Hazards Model ◽

Serious Adverse Event ◽

Loss To Follow Up ◽

Factors Associated ◽

Mdr Tb

Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.

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Local Antimicrobial Treatment in Orthopaedic Surgery

Journal of Bone and Joint Infection ◽

10.7150/jbji.9465 ◽

2017 ◽

Vol 2 (1) ◽

pp. 1-2

Author(s):

Antonia F. Chen ◽

Heinz Winkler

Keyword(s):

Basic Science ◽

Orthopaedic Surgery ◽

Clinical Evidence ◽

Joint Infection ◽

Antimicrobial Treatment ◽

Special Issue ◽

Orthopaedic Surgeons ◽

Bone And Joint Infection

Abstract. The purpose of this special issue of Journal of Bone and Joint Infection is to provide orthopaedic surgeons with basic science explanations as to how these local antimicrobials work, clinical evidence that supports these local treatments, and the role of these local treatments against biofilm.

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Correction to: Real‑world experience with dalbavancin therapy in gram‑positive skin and soft tissue infection, bone and joint infection

Infection ◽

10.1007/s15010-019-01372-9 ◽

2019 ◽

Vol 48 (1) ◽

pp. 149-149

Author(s):

Selma Tobudic ◽

Christina Forstner ◽

Heinz Burgmann ◽

Heimo Lagler ◽

Christoph Steininger ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Infection ◽

Real World ◽

Joint Infection ◽

Tissue Infection ◽

Original Version ◽

Gram Positive ◽

Positive Skin ◽

Bone And Joint Infection ◽

Corrected Figure

The original version of this article unfortunately contained a mistake. The presentation of Fig. 1 was incorrect. The corrected figure is given below.

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