Teicoplanin combined with conventional vancomycin therapy for the treatment of pulmonary methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis infections

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the most common pathogens causing pediatric infections including skin and soft tissue infections, pyogenic arthritis, osteomyelitis, and septic shock. For decades, patients were treated with antibiotics such as vancomycin and clindamycin, but there is an increasing incidence of resistance to these traditional therapies. We describe 2 cases of patients with CA-MRSA invasive infections with bacteremia who experienced vancomycin therapy failure but who were successfully treated with ceftaroline fosamil. Case 1 involves an 8-year-old Hispanic male who was diagnosed with CA-MRSA bacteremia, thigh abscess, and osteomyelitis. The patient was admitted to the pediatric intensive care unit in septic shock. Case 2 involves an 8-year-old Caucasian male who was diagnosed with CA-MRSA sepsis, right arm abscess, and osteomyelitis. We were able to successfully treat both patients with CA-MRSA sepsis and invasive infection—who failed vancomycin therapy—with ceftaroline fosamil with no adverse efiects. Despite the positive outcome in both pediatric patients, clinical trials with ceftaroline fosamil are needed to further support its use in pediatric patients.

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Adaptation of Methicillin-Resistant Staphylococcus aureus in the Face of Vancomycin Therapy

Clinical Infectious Diseases ◽

10.1086/491713 ◽

2006 ◽

Vol 42 (Supplement_1) ◽

pp. S40-S50 ◽

Cited By ~ 113

Author(s):

George Sakoulas ◽

Robert C. Moellering ◽

George M. Eliopoulos

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Vancomycin Therapy ◽

Methicillin Resistant ◽

The Face

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Clinical Outcomes of Linezolid vs Vancomycin in Methicillin-Resistant Staphylococcus aureus Ventilator-Associated Pneumonia

Journal of Intensive Care Medicine ◽

10.1177/0885066610392893 ◽

2011 ◽

Vol 26 (6) ◽

pp. 385-391 ◽

Cited By ~ 19

Author(s):

Jeannie D. Chan ◽

Tam N. Pham ◽

Jenny Wong ◽

Michelle Hessel ◽

Joseph Cuschieri ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Clinical Cure ◽

Methicillin Resistant Staphylococcus Aureus ◽

Signs And Symptoms ◽

Ventilator Associated Pneumonia ◽

Vancomycin Therapy ◽

Methicillin Resistant ◽

Treatment Standard ◽

Primary Endpoints ◽

Days Of Therapy

Background: Vancomycin has been the treatment standard for methicillin-resistant Staphylococcus aureus (MRSA) infections, but clinical efficacy is limited. We report outcomes of a cohort with MRSA ventilator-associated pneumonia (VAP) treated with vancomycin vs linezolid. Methods: Retrospective analysis of 113 participants with MRSA VAP confirmed by bronchoscopy who have been initiated on therapy with either vancomycin or linezolid within 24 hours after bronchoscopy and completed ≥7 days of therapy during their hospitalization from July 2003 to June 2007. The primary endpoints were hospital survival and clinical cure, defined as resolution of signs and symptoms of VAP or microbiological eradication after completion of therapy along with clinical pulmonary infection score (CPIS) ≤6 at day 7 of therapy. Results: At hospital discharge, 23/27 (85.2%) of linezolid and 72/86 (83.7%) of vancomycin recipients had survived ( P = .672). In comparison to linezolid recipients, the adjusted odds ratio (OR) for survival was 0.72 (95% confidence interval [CI]: 0.16-3.27) with vancomycin therapy. Clinical cure was achieved in 24/27 (88.9%) of linezolid and 63/86 (73.3%) of vancomycin recipients ( P = .066). Compared to linezolid recipients, the adjusted OR for clinical cure was 0.24 (95% CI: 0.05-1.10) with vancomycin therapy. Survival and clinical cure did not differ significantly between vancomycin recipients with trough level ≥15 and <15 μg/mL, respectively. Conclusions: Our results suggested no survival benefit but a trend toward higher cure rate with linezolid therapy. The optimal treatment of MRSA VAP requires further study through randomized, controlled trials.

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