Use of Tedizolid for the Treatment of Staphylococcus aureus Bacteremia – An off Labelled Indication

Aims: We aim to share our experience in the successful use of tedizolid for the treatment of Staphylococcus aureus bacteremia in two of our patients. Presentation of Cases: Our first patient had methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The MRSA isolated was sensitive to linezolid and vancomycin (MIC=2), resistant to daptomycin (MIC=2). In view of the documented drug allergy to ceftriaxone and drug interaction with daptomycin, the patient was initially initiated on intravenous vancomycin but developed a breakthrough fever with rising inflammatory markers. However, upon initiation of tedizolid, fever lysed and the patient improved clinically. Our second patient has end–stage renal failure on hemodialysis. The patient has methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bloodstream infection. The MSSA isolated was sensitive to vancomycin (MIC=2) and ceftaroline (MIC=0.50), but resistant to daptomycin (MIC=2). Vancomycin was initiated in view of documented drug allergy to ceftriaxone but repeated blood cultures showed the persistence of MSSA. Antibiotics were switched to linezolid for 3 days before switching to tedizolid due to previous neutropenia with linezolid. Blood cultures had documented clearance with tedizolid. Discussion and Conclusion: In both our patients, tedizolid was introduced after a few days of vancomycin therapy. Hence, the efficacy of tedizolid as the first-line therapy for the treatment of staphylococcus bacteremia remains unknown. Nevertheless, in both patients, there was no relapse of staphylococcus bacteremia when tedizolid was used to complete the antibiotic therapy. The optimal treatment duration of staphylococcus bacteremia with tedizolid also remains unknown.

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1338. Analysis of Prescription Guideline Adherence in Pediatric Outpatient Pneumonia Treatment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1520 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S680-S681

Author(s):

Carly Heck ◽

Judith Martin ◽

Marcia Kurs-Lasky

Keyword(s):

Drug Allergy ◽

Health Concern ◽

Second Line ◽

First Line ◽

Second Line Therapy ◽

First Line Therapy ◽

Line Therapy ◽

Comparison Results ◽

Significant Difference ◽

Recommended Therapy

Abstract Background Background: Antibiotic resistance is a major public health concern. A modifiable intervention is outpatient antibiotic stewardship. The goal of this study was to review the electronic health records (EHR) of children diagnosed with community acquired pneumonia (CAP) to compare patients who received non-guideline concordant therapy with those prescribed recommended therapy. Methods Methods: This was a retrospective chart review of 300 children (6 months to 6 years old) with an outpatient diagnosis of CAP between July 2017 and June 2019. 45 Children’s Hospital of Pittsburgh (CHP) and UPMC Children’s Community Pediatrics (CCP) practices were included. CHP practices are academic-based with trainees involved in visits, while CCP practices do not include trainees. First-line recommended therapy was defined as amoxicillin, second-line therapy as azithromycin or amoxicillin-clavulanate, and all other prescriptions were defined as other. Patients prescribed first-line therapy were compared to patients with second-line therapy or other. If first-line therapy was not prescribed, the EHR was manually reviewed for justification. If drug allergy was listed, the medication allergy and type of reaction were recorded. Results Results: In this study the minority of children (43%) were prescribed first-line therapy. This group was younger (57 vs. 63 months of age), more likely to be Non-white (80%), and seen at the CHP locations than those prescribed non-guideline concordant therapy. The average symptom duration was shorter, heart rate and respiratory rate were higher and the presence of fever was more common in the first-line therapy group. Justification for non-guideline therapy was most often reported as to provide coverage for atypical organisms. The most common drug allergy recorded was amoxicillin, and urticaria with unknown timing was the most common type of reaction. Demographics Comparison Results Justification for Second-line / Other Therapy and Drug Allergy Results Conclusion This project observed a high proportion of children being prescribed non-guideline concordant therapy for a diagnosis of CAP. Age, race, practice location, and severity of illness measures showed a statistically significant difference between groups. This study highlights the importance of education which reviews the current guidelines and the most likely pathogens for children with CAP. Disclosures All Authors: No reported disclosures

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Pediatric pharmaceutical care with anti-infective medication in a patient with acute hematogenous osteomyelitis caused by methicillin-resistant Staphylococcus aureus

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420925713 ◽

2020 ◽

Vol 34 ◽

pp. 205873842092571

Author(s):

Chanmei Lv ◽

Jiantao Lv ◽

Yue Liu ◽

Qifeng Liu ◽

Dongna Zou

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

First Line ◽

Methicillin Resistant ◽

First Report ◽

First Line Therapy ◽

Acute Hematogenous Osteomyelitis ◽

Serious Infections ◽

Daily Dose ◽

Red Man Syndrome

The infection of the bone marrow system caused by methicillin-resistant Staphylococcus aureus (MRSA) leads to a variety of common diseases which usually occur in children under the age of 12. Vancomycin (VCM) is the first-line therapy for MRSA-caused serious infections such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe skin and soft-tissue infection (e.g. necrotizing fasciitis) with a recommended dosage of 15–20 μg/mL. In this study, we first report a case of a child with MRSA-caused osteomyelitis who was successfully cured by VCM at a concentration of 4.86 μg/mL. VCM’s clinical daily dose of more than 4 g was of concern in light of recent evidence suggesting the increased risks of nephrotoxicity and red man syndrome when Cmin ⩾15 μg/mL and doses ⩾10 mg/kg in children. As far as we know, this is the first report on the lower dose of VCM in children with MRSA osteomyelitis.

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