title: Use of quinupristin/dalfopristin in a critical patient with a methicillin-resistant Staphilococcus aureus infection.
abstract: 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.
authors.affiliation: Department of Anesthesia and Intensive Care, Federico II University, Naples, Italy. ederober@unina.it
authors.forename: E
authors.initials: E
authors.lastname: De Robertis
authors.forename: D
authors.initials: D
authors.lastname: Viscidi
authors.forename: G
authors.initials: G
authors.lastname: Servillo
authors.forename: M
authors.initials: M
authors.lastname: Pezza
authors.forename: O
authors.initials: O
authors.lastname: Piazza
authors.forename: C A
authors.initials: CA
authors.lastname: Giuliano
authors.forename: R
authors.initials: R
authors.lastname: Tufano
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016638:Critical Illness; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014769:Virginiamycin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D014951:Wounds, Stab / Q000150:complications / Q000000981:diagnostic imaging
chemical_list: D000900:Anti-Bacterial Agents; D014769:Virginiamycin; C113825:quinupristin