title: Oral pristinamycin for the treatment of resistant Gram-positive infections in patients with cancer: Evaluation of clinical outcomes.
abstract: Pristinamycin has been used to treat a range of Gram-positive infections, but reported experience in patients with malignancy is limited. This study aimed to evaluate the use of pristinamycin in patients with cancer at an Australian centre. All patients commenced on oral pristinamycin therapy at the Peter MacCallum Cancer Centre between January 2005 and December 2014 were identified using the hospital pharmacy dispensing system. Information on demographics, co-morbidities, cancer diagnosis, infection characteristics, pristinamycin regimen, pristinamycin tolerability and outcomes was collected. The median duration of follow-up was 398 days. In total, 26 patients received pristinamycin, with median age of 61 years and a male predominance (65%). Underlying diagnoses were haematological malignancies (50%) and solid tumours (50%). Pathogens included 13 meticillin-resistant Staphylococcus aureus, 6 vancomycin-resistant Enterococcus faecium, 4 meticillin-resistant Staphylococcus epidermidis, 2 meticillin-susceptible S. aureus and 1 vancomycin-susceptible E. faecium. Infection sites were osteomyelitis (6), skin and soft-tissue (4), intra-abdominal/pelvic abscess (4), bloodstream (3), empyema (3), endocarditis/endovascular (3), prosthesis-related infection (2) and epididymo-orchitis (1). One patient ceased pristinamycin due to nausea. Regarding outcome, 13 patients (50%) were cured of infection, 8 (31%) had suppression and 5 (19%) had relapse. Relapses included 1 endovascular infection, 2 episodes of osteomyelitis, 1 pelvic abscess and 1 skin and soft-tissue infection. Overall, 81% of patients achieved cure or suppression of antibiotic-resistant or complex Gram-positive infections, consistent with published experience in non-cancer populations. A favourable tolerability profile makes oral pristinamycin a viable treatment option, particularly in settings where outpatient management of cancer is the objective.
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia. Electronic address: jasmine.teng@petermac.org.
authors.forename: J C
authors.initials: JC
authors.lastname: Teng
authors.affiliation: Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Lingaratnam
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Trubiano
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia.
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia.
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC 3000, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001315:Australia; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D025762:Pristinamycin / Q000008:administration & dosage*; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D025762:Pristinamycin
keywords: Antibiotic resistance; Cancer; Pristinamycin