scholarly journals Treatment of intracranial infection caused by methicillin-resistant Staphylococcus epidermidis with linezolid following poor outcome of vancomycin therapy: A case report and literature review

2020 ◽  
Author(s):  
Zhiqiang Lin ◽  
Sumei Chen ◽  
Limian Hong ◽  
Shuifa Wu ◽  
Xueping Yu
Keyword(s):  
Staphylococcus Epidermidis ◽  
Drug Susceptibility ◽  
Therapeutic Effects ◽  
Optimal Management ◽  
Vancomycin Therapy ◽  
Case Presentation ◽  
Methicillin Resistant ◽  
Intracranial Infection ◽  
Poor Outcome ◽  
Vancomycin Mics

Abstract Background: To investigate the efficacy of linezolid in the treatment of intracranial infection caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant coagulase-negative Staphylococcus (MRCoNS).Case presentation: The patient at our hospital was diagnosed with methicillin-resistant Staphylococcus epidermidis (MRSE) intracranial infection, which was resistant to oxacillin and sensitive to vancomycin (MIC = 2 µg/mL) and linezolid (MIC = 4 µg/mL). Vancomycin was replaced with linezolid after 36 days of treatment due to poor outcome, and the patient was eventually cured. Further, a total of 23 cases of intracranial MRSA/MRCoNS infections were reported, of which 1 case with MRSA had a vancomycin MIC = 1 µg/mL, while the remaining 22 cases had vancomycin MICs greater than 1 µg/mL, with MIC = 1.5 µg/mL in 1 case, MIC = 2 µg/mL in 19 cases and MIC = 4 µg/mL in 2 cases. The linezolid-containing regimen was used after drug susceptibility results or if the initial treatment failed, leading to recovery in 19 patients, microbial clearance in 3 patients (of which 2 patients died of comorbidities and 1 patient died of Pseudomonas aeruginosa infection), and treatment failure in 1 case.Conclusion: The PK/PD parameter for evaluating the efficacy of vancomycin is AUC/MIC ≥ 400 (assuming a vancomycin MICBMD of 1 µg/mL), and trough concentration should not be used as a substitute for AUC/MIC. For optimal management, vancomycin dosing should be based on AUC-guided dosing and monitoring. When the vancomycin MIC of MRSA/MRCoNS is > 1 µg/mL, the target AUC/MIC cannot be achieved. In such cases, linezolid can be used with good therapeutic effects.

scholarly journals Vancomycin In Vitro Bactericidal Activity and Its Relationship to Efficacy in Clearance of Methicillin-Resistant Staphylococcus aureus Bacteremia

2007 ◽  
Vol 51 (7) ◽  
pp. 2582-2586 ◽  
Author(s):  
Pamela A. Moise ◽  
George Sakoulas ◽  
Alan Forrest ◽  
Jerome J. Schentag
Keyword(s):  
Staphylococcus Aureus ◽  
Median Time ◽  
Bactericidal Activity ◽  
Peak Plasma ◽  
Plasma Concentrations ◽  
Accessory Gene ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Vancomycin Mics

ABSTRACT We examined the relationship between the time to clearance of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia while patients were receiving vancomycin therapy and the in vitro bactericidal activity of vancomycin. Vancomycin killing assays were performed with 34 MRSA bloodstream isolates (17 accessory gene regulator group II [agr-II] and 17 non-agr-II isolates) from 34 different patients with MRSA bacteremia for whom clinical and microbiological outcomes data were available. Vancomycin doses were prospectively adjusted to achieve peak plasma concentrations of 28 to 32 μg/ml and trough concentrations of 8 to 12 μg/ml. Bactericidal assays were performed over 24 h with ∼107 to 108 CFU/ml in broth containing 16 μg/ml vancomycin. The median time to clearance of bacteremia was 6.5 days for patients with MRSA isolates demonstrating ≥2.5 reductions in log10 CFU/ml at 24 h and >10.5 days for patients with MRSA isolates demonstrating <2.5 log10 CFU/ml by 24 h (P = 0.025). The median time to clearance was significantly longer with MRSA isolates with vancomycin MICs of 2.0 μg/ml compared to that with MRSA isolates with MICs of ≤1.0 μg/ml (P = 0.019). The bacteremia caused by MRSA isolates with absent or severely reduced delta-hemolysin expression was of a longer duration of bacteremia (10 days and 6.5 days, respectively; P = 0.27) and had a decreased probability of eradication (44% and 78%, respectively; P = 0.086). We conclude that strain-specific microbiological features of MRSA, such as increased vancomycin MICs and decreased killing by vancomycin, appear to be predictive of prolonged MRSA bacteremia while patients are receiving vancomycin therapy. Prolonged bacteremia and decreased delta-hemolysin expression may also be related. Evaluation of these properties may be useful in the consideration of antimicrobial therapies that can be used as alternatives to vancomycin for the treatment of MRSA bacteremia.

scholarly journals Successful Use of Daptomycin in a Preterm Neonate With Persistent Methicillin-Resistant Staphylococcus epidermidis Bacteremia

2015 ◽  
Vol 20 (1) ◽  
pp. 61-65
Author(s):  
Kristen M. Gawronski
Keyword(s):  
Staphylococcus Epidermidis ◽  
Preterm Neonate ◽  
Neonatal Period ◽  
Serum Levels ◽  
Limited Information ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Drug Of Choice ◽  
Trough Serum ◽  
Neonatal Population

There is limited information regarding the use of daptomycin in the neonatal population, and dosage adjustments for neonates with renal dysfunction. We report on the successful use of daptomycin in a 1-month-old, former 24-week gestation neonate with persistent methicillin-resistant Staphylococcus epidermidis (MRSE) bacteremia and impaired renal function. We also review the available literature supporting daptomycin use in the neonatal period. Daptomycin peak and trough serum levels were obtained immediately prior to and 60 minutes after the fifth dose. While vancomycin remains the drug of choice for methicillin-resistant Staphylococcal infections, due to increasing reports of treatment failures, alternative therapies are recommended. Based on mounting evidence, daptomycin may be considered an option in persistently bacteremic neonates who fail vancomycin therapy, although further investigation is warranted.

Heterogeneously Vancomycin-Resistant Staphylococcus epidermidis Strain Causing Recurrent Peritonitis in a Dialysis Patient during Vancomycin Therapy

1999 ◽  
Vol 37 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Krzysztof Sieradzki ◽  
Richard B. Roberts ◽  
David Serur ◽  
Judie Hargrave ◽  
Alexander Tomasz
Keyword(s):  
Staphylococcus Epidermidis ◽  
Exit Site ◽  
Vancomycin Therapy ◽  
Single Strain ◽  
Microbiological Methods ◽  
Vancomycin Mics ◽  
Vancomycin Resistant ◽  
Prophylactic Use ◽  
Similar Enrichment

Methicillin-resistant Staphylococcus epidermidis (MRSE) was recovered over a 2-month period from the dialysis fluid of a peritoneal dialysis (PD) patient who experienced recurrent episodes of peritonitis during therapeutic and prophylactic use of vancomycin. Characterization of five consecutive MRSE isolates by molecular and microbiological methods showed that they were representatives of a single strain, had reduced susceptibility to vancomycin, did not react with DNA probes specific for the enterococcal vanA orvanB gene, and showed characteristics reminiscent of the properties of a recently described vancomycin-resistant laboratory mutant of Staphylococcus aureus. Cultures of these MRSE isolates were heterogeneous: they contained—with a frequency of 10−4 to 10−5—bacteria for which vancomycin MICs were high (25 to 50 μg/ml) which could easily be selected to “take over” the cultures by using vancomycin selection in the laboratory. In contrast, the five consecutive MRSE isolates recovered from the PD patient during virtually continuous vancomycin therapy showed no indication for a similar enrichment of more resistant subpopulations, suggesting the existence of an “occult” infection site in the patient (presumably at the catheter exit site) which was not accessible to the antibiotic.

scholarly journals Relationship between Vancomycin MIC and Failure among Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia Treated with Vancomycin

2008 ◽  
Vol 52 (9) ◽  
pp. 3315-3320 ◽  
Author(s):  
T. P. Lodise ◽  
J. Graves ◽  
A. Evans ◽  
E. Graffunder ◽  
M. Helmecke ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Fold Increase ◽  
Classification And Regression Tree ◽  
Inclusion Criteria ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Adjusted Risk ◽  
Cart Analysis ◽  
Vancomycin Mics

ABSTRACT There is growing concern that vancomycin has diminished activity for methicillin-resistant Staphylococcus aureus (MRSA) infections, with vancomycin MICs at the high end of the CLSI susceptibility range. Despite this growing concern, there are limited clinical data to support this notion. To better elucidate this, a retrospective cohort study was conducted among patients with MRSA bloodstream infections who were treated with vancomycin between January 2005 and May 2007. The inclusion criteria were as follows: at least 18 years old, nonneutropenic, with an MRSA culture that met the CDC criteria for bloodstream infection, had received vancomycin therapy within 48 h of the index blood culture, and survived >24 h after vancomycin administration. Failure was defined as 30-day mortality, bacteremia ≥10 days on vancomycin therapy, or a recurrence of MRSA bacteremia within 60 days of vancomycin discontinuation. Classification and regression tree (CART) analysis identified the vancomycin MIC breakpoint associated with an increased probability of failure. During the study period, 92 patients met the inclusion criteria. The vancomycin MIC breakpoint derived by CART analysis was ≥1.5 mg/liter. The 66 patients with vancomycin MICs of ≥1.5 mg/liter had a 2.4-fold increase in failure compared to patients with MICs of ≤1.0 mg/liter (36.4% and 15.4%, respectively; P = 0.049). In the Poisson regression, a vancomycin MIC of ≥1.5 mg/liter was independently associated with failure (adjusted risk ratio, 2.6; 95% confidence interval, 1.3 to 5.4; P = 0.01). These data strongly suggest that patients with MRSA bloodstream infections with vancomycin MICs of ≥1.5 mg/liter respond poorly to vancomycin. Alternative anti-MRSA therapies should be considered for these patients.

scholarly journals Daptomycin Is Effective for Treatment of Experimental Endocarditis Due to Methicillin-Resistant and Glycopeptide-Intermediate Staphylococcus epidermidis

2010 ◽  
Vol 54 (7) ◽  
pp. 2781-2786 ◽  
Author(s):  
C. García-de-la-Mària ◽  
F. Marco ◽  
Y. Armero ◽  
D. Soy ◽  
A. Moreno ◽  
...  
Keyword(s):  
Body Weight ◽  
Staphylococcus Epidermidis ◽  
Standard Dose ◽  
Rabbit Model ◽  
High Dose ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Different Doses ◽  
All Treatment

ABSTRACT This study evaluated the daptomycin activity against two methicillin-resistant Staphylococcus epidermidis (MRSE) clinical isolates with different vancomycin susceptibilities: MRSE-375, with a vancomycin MIC of 2 μg/ml, and NRS6, a glycopeptide-intermediate S. epidermidis (GISE) strain with a vancomycin MIC of 8 μg/ml. The in vivo activity of daptomycin at two different doses (standard dose [SD-daptomycin], 6 mg/kg of body weight/day intravenously [i.v.]; high dose [HD-daptomycin], 10 mg/kg/day i.v.) was evaluated in a rabbit model of infective endocarditis and compared with that of a standard dose of vancomycin (SD-vancomycin; 1 g i.v. every 12 h) for 2 days. For the MRSE-375 strain, high-dose vancomycin (HD-vancomycin; 1 g i.v. every 6 h) was also studied. For MRSE-375, SD- and HD-daptomycin therapy sterilized significantly more vegetations than SD-vancomycin therapy (9/15 [60%] and 11/15 [73%] vegetations, respectively, versus 3/16 [19%] vegetations; P = 0.02 and P = 0.002, respectively). HD-daptomycin sterilized more vegetations than HD-vancomycin (11/15 [73%] versus 5/15 [33%] vegetations; P = 0.03) and was more effective than SD- and HD-vancomycin in reducing the density of bacteria in valve vegetations (0 log10 CFU/g vegetation [interquartile range {IQR}, 0 to 1 log10 CFU/g vegetation] versus 2 log10 CFU/g vegetation [IQR, 2 to 2 log10 CFU/g vegetation] and 2 log10 CFU/g vegetation [IQR, 0 to 2.8 log10 CFU/g vegetation]; P = 0.002 and P = 0.01, respectively). For the NRS6 strain, SD- and HD-daptomycin were significantly more effective than vancomycin in reducing the density of bacteria in valve vegetations (3.7 log10 CFU/g vegetation [IQR, 2 to 6 log10 CFU/g vegetation] versus 7.1 log10 CFU/g vegetation [IQR, 5.2 to 8.5 log10 CFU/g vegetation]; P = 0.02). In all treatment arms, isolates recovered from vegetations remained susceptible to daptomycin and vancomycin and had the same MICs. In conclusion, daptomycin at doses of 6 mg/kg/day or 10 mg/kg/day is more effective than vancomycin for the treatment of experimental endocarditis due to MRSE and GISE.

scholarly journals Strong Antimicrobial and Healing Effects of Beta-Acids from Hops in Methicillin-Resistant Staphylococcus aureus-Infected External Wounds In Vivo

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 708
Author(s):  
Radek Sleha ◽  
Vera Radochova ◽  
Jiri Malis ◽  
Alexander Mikyska ◽  
Milan Houska ◽  
...  
Keyword(s):  
Wound Healing ◽  
Porcine Model ◽  
Therapeutic Effects ◽  
Methicillin Resistant ◽  
Antimicrobial Effects ◽  
Therapeutic Modalities ◽  
Positive Effects ◽  
Inflammatory Parameters

Staphylococcus (S.) aureus is an important causative agent of wound infections with increasing incidence in the past decades. Specifically, the emergence of methicillin-resistant S. aureus (MRSA) causes serious problems, especially in nosocomial infections. Therefore, there is an urgent need to develop of alternative or supportive antimicrobial therapeutic modalities to meet these challenges. Purified compounds from hops have previously shown promising antimicrobial effects against MRSA isolates in vitro. In this study, purified beta-acids from hops were tested for their potential antimicrobial and healing properties using a porcine model of wounds infected by MRSA. The results show highly significant antimicrobial effects of the active substance in both the powder and Ambiderman-based application forms compared to both no-treatment control and treatment with Framycoin. Moreover, the macroscopic evaluation of the wounds during the treatment using the standardized Wound Healing Continuum indicated positive effects of the beta-acids on the overall wound healing. This is further supported by the microscopic data, which showed a clear improvement of the inflammatory parameters in the wounds treated by beta-acids. Thus, using the porcine model, we demonstrate significant therapeutic effects of hops compounds in the management of wounds infected by MRSA. Beta-acids from hops, therefore, represent a suitable candidate for the treatment of non-responsive nosocomial tissue infections by MRSA.

scholarly journals Isolation of Mycobacterium talmoniae from a patient with diffuse panbronchiolitis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tomoko Suzuki ◽  
Miwako Saitou ◽  
Yuriko Igarashi ◽  
Satoshi Mitarai ◽  
Katsunao Niitsuma
Keyword(s):  
Combination Therapy ◽  
Bronchoalveolar Lavage Fluid ◽  
Left Lung ◽  
Lavage Fluid ◽  
Drug Susceptibility ◽  
Acid Fast Bacillus ◽  
Case Presentation ◽  
Diffuse Panbronchiolitis ◽  
Potential Pathogen ◽  
Culture Positive

Abstract Background Mycobacterium (M) talmoniae isolated from a patient with cystic fibrosis was first described in 2017, and cases of M. talmoniae remain exceedingly rare. Case presentation A 51-year-old woman had respiratory symptoms for 10 years. Diffuse panbronchiolitis (DPB) was detected at the first visit at our hospital. A cavity lesion in the apex of the left lung was found, and sputum and bronchoalveolar lavage fluid were acid-fast bacillus (AFB) smear- and culture-positive besides Pseudomonas aeruginosa. M. talmoniae was finally identified, and the standard combination therapy for non-tuberculous mycobacteria (NTM) was administered for 2 y referring to the drug-susceptibility test. Thereafter, the AFB culture was negative, the wall thickness of the lung cavity was ameliorated, and oxygen saturation improved. Conclusions We encountered a rare case of M. talmoniae with DPB, for which standard combination therapy was effective. M. talmoniae may be considered a potential pathogen of lung disease, especially in patients with bronchiectatic lesions.

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