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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 October;70(10):747-51

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

De Robertis E., Viscidi D., Servillo G., Pezza M., Piazza O., Giuliano C. A., Tufano R.

Department of Anesthesia and Intensive Care “Federico II” University, Naples, Italy


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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.

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