title: Role of quinupristin/dalfopristin in the treatment of Gram-positive nosocomial infections in haematological or oncological patients.
abstract: Gram-positive pathogens, primarily Staphylococcus aureus, coagulase-negative staphylococci, viridans group streptococci, and enterococci, are now the predominant causes of infection in neutropenic haematology/oncology patients, but are often resistant to multiple antibiotics. Glycopeptides have been the only alternative antibiotic treatments for multidrug-resistant Gram-positive infections to date. However, glycopeptides are not always effective or well tolerated, and can produce nephrotoxic or ototoxic effects. Quinupristin/dalfopristin is a recently introduced streptogramin antibiotic that is active in vitro against most of the major Gram-positive pathogens causing infection in neutropenic patients. Recent studies of the in vitro susceptibility of clinical isolates of Gram-positive pathogens to quinupristin/dalfopristin are summarized. Pre-clinical and clinical studies of the efficacy and safety of quinupristin/dalfopristin in the treatment of Gram-positive infections are reviewed. Quinupristin/dalfopristin is active in vitro against the vast majority of recent isolates of relevant Gram-positive pathogens, including methicillin-resistant staphylococci, viridans group streptococci, and vancomycin-resistant Enterococcus faecium, but excluding Enterococcus faecalis. Pre-clinical and clinical data indicate the efficacy of quinupristin/dalfopristin in infections caused by these organisms, including bacteraemia and catheter-related infections. Quinupristin/dalfopristin is not associated with nephrotoxicity or ototoxicity. Quinupristin/dalfopristin is a potential alternative to glycopeptides in haematology or oncology patients with multidrug-resistant Gram-positive infections, especially those who are unresponsive to, or intolerant of, glycopeptides.
authors.affiliation: Department of Medicine, Institut Jules Bordet, Bruxelles, Belgium. jean.klastersky@bordet.be
authors.forename: J
authors.initials: J
authors.lastname: Klastersky
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014769:Virginiamycin / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C113825:quinupristin; C113826:dalfopristin