CLINICAL CASES Free access

Minerva Anestesiologica 2004 October;70(10):747-51

Copyright © 2004 EDIZIONI MINERVA MEDICA

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

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.