title: Treatment of vancomycin-resistant Enterococcus faecium infections with quinupristin/dalfopristin.
abstract: Clinicians caring for patients with vancomycin-resistant Enterococcus faecium (VREF) infections face severe constraints in the selection of treatment. Quinupristin/dalfopristin (Synercid) is active in vitro against VREF, with a MIC(90) of 1.0 microg/mL. We investigated the clinical efficacy and safety of this agent in a multicenter, prospective, noncomparative, emergency-use study of 396 patients. Patients were included if they had signs and symptoms of active infection, including bacteremia of unknown origin, intra-abdominal infection, and skin and skin-structure infection, with no alternative antibiotic therapy available. The mean duration of treatment was 20 days (range, 4-40 days). The clinical response rate was 68.8% in the evaluable subset, and the overall response rate was 65.6%. The most common adverse events related to quinupristin/dalfopristin were arthralgias and myalgias. Related laboratory abnormalities were rare. In this severely ill patient population, quinupristin/dalfopristin was efficacious and demonstrated an acceptable safety profile in the treatment of VREF infection.
authors.affiliation: University of Pittsburgh Medical Center, Division of Critical Care Medicine, Pittsburgh, PA 15213, USA. lindenpk@anes.upmc.edu
authors.forename: P K
authors.initials: PK
authors.lastname: Linden
authors.forename: R C
authors.initials: RC
authors.lastname: Moellering
authors.forename: C A
authors.initials: CA
authors.lastname: Wood
authors.forename: S J
authors.initials: SJ
authors.lastname: Rehm
authors.forename: J
authors.initials: J
authors.lastname: Flaherty
authors.forename: F
authors.initials: F
authors.lastname: Bompart
authors.forename: G H
authors.initials: GH
authors.lastname: Talbot
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D016984:Enterococcus faecium; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D015163:Superinfection / Q000150:complications; D016896:Treatment Outcome; D020713:Vancomycin Resistance; D014769:Virginiamycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C062940:quinupristin-dalfopristin