title: Treatment of vancomycin-resistant Enterococcus faecium infections with an investigational streptogramin antibiotic (quinupristin/dalfopristin): a report of fifteen cases.
abstract: New therapies for vancomycin-resistant Enterococcus faecium (VREF) infections are urgently needed. We describe the treatment of 15 patients with VREF infection with quinupristin/dalfopristin (RP 59500), a new injectable streptogramin antibiotic. Primary infections treated were bacteremia (4), urinary tract (4), intraabdominal (5), otitis externa (1), and meningitis (1). Minimum inhibitory concentrations for quinupristin/dalfopristin ranged from 0.5 microgram/ml or less to 2 micrograms/ml, and minimum bactericidal concentrations were greater than 64 micrograms/ml for all VREF isolates tested. Peak serum inhibitory titers following infusion of quinupristin/dalfopristin ranged from 1:8 to 1:64; all bactericidal titers were less than 1:2. Development of resistance to quinupristin/dalfopristin during therapy was not observed. The only drug-related adverse effect noted was phlebitis in 4 patients; all had received quinupristin/dalfopristin by peripheral venous infusion. Three patients had clinical and bacteriologic cures. Relapses occurred in 5 patients with recovery of VREF from infected sites in post-treatment cultures. Ten patients died of severe underlying disease; VREF was believed to contribute directly to the death of only 1 patient. While evaluation of clinical efficacy was complicated by the severity of underlying disease in patients with VREF infection, our experience suggests that quinupristin/dalfopristin is a safe and potentially useful agent for the treatment of VREF infections.
authors.affiliation: Infectious Diseases Section, Department of Veterans Affairs Medical Center, East Orange, New Jersey 07018, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Dever
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Dejesus
authors.forename: M
authors.initials: M
authors.lastname: Masurekar
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.forename: Z C
authors.initials: ZC
authors.lastname: Kaminski
authors.forename: W G
authors.initials: WG
authors.lastname: Johanson
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004269:DNA, Bacterial / Q000032:analysis / Q000096:biosynthesis / Q000302:isolation & purification; D004352:Drug Resistance, Microbial; D004591:Electrophoresis, Polyacrylamide Gel; D016984:Enterococcus faecium / Q000187:drug effects*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014640:Vancomycin / Q000494:pharmacology; D014769:Virginiamycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D014769:Virginiamycin; C062940:quinupristin-dalfopristin; D014640:Vancomycin