title: Pristinamycin as adjunctive therapy in the management of Gram-positive multi-drug resistant organism (MDRO) osteoarticular infection.
abstract: OBJECTIVE
  Osteoarticular infection often requires prolonged antibiotic therapy as an adjunct to surgery. We report our experience using pristinamycin, an oral streptogramin, when conventional antibiotics were poorly tolerated or inappropriate because of multi-drug resistant organisms (MDROs).
  
  
  METHODS
  We retrospectively identified, from pharmacy records, all patients prescribed pristinamycin between 1/1/2004 and 31/12/2006. We collected clinical and microbiological data.
  
  
  RESULTS
  Twenty-one patients were identified (13 male and eight female patients, age range 18-83 years). Sixteen patients (76%) had infection due to MDROs and five (24%) were intolerant of conventional antibiotics. Ten patients received other concurrent oral antibiotics. Eleven of 21 (52%) patients remained free of recurrent infection off antibiotics at a mean follow up duration of 13 months, (range 4-25 months). Suppression of infection while still on therapy was achieved in a further four patients (19%) with a mean follow up of 11.5 months (range 5-15 months). Six patients (29%) failed therapy, all requiring a further surgical procedure.
  
  
  CONCLUSIONS
  Oral pristinamycin was a well tolerated and useful adjunctive treatment in this group with complex orthopaedic infection. Pristinamycin can be considered in patients with osteoarticular infection due to Gram-positive organisms when antibiotic multi-resistance or intolerance makes conventional therapies impossible.
  
  
  CONCLUSIONS
  We report our experiences of using pristinamycin in the management of 21 patients with Gram-positive MDRO osteoarticular infection or who were unable to tolerate more conventional regimens. Our results show that pristinamycin is well tolerated with outcomes comparable to those of other agents described in the literature on osteoarticular infection.
authors.affiliation: Bone Infection Unit, Department of Infectious Diseases, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK. neilruparelia@doctors.org.uk
authors.forename: N
authors.initials: N
authors.lastname: Ruparelia
authors.forename: B L
authors.initials: BL
authors.lastname: Atkins
authors.forename: J
authors.initials: J
authors.lastname: Hemingway
authors.forename: A R
authors.initials: AR
authors.lastname: Berendt
authors.forename: I
authors.initials: I
authors.lastname: Byren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D025762:Pristinamycin / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D025762:Pristinamycin