Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration.
BACKGROUND
Staphylococci represent the first etiologic agents of bone and joint infection (BJI), leading glycopeptides use, especially in case of methicillin-resistance or betalactam intolerance. Teicoplanin may represent an alternative to vancomycin because of its acceptable bone penetration and possible subcutaneous administration.


METHODS
Adults receiving teicoplanin for S. aureus BJI were included in a retrospective cohort study investigating intravenous or subcutaneous teicoplanin safety and pharmacokinetics.


RESULTS
Sixty-five S. aureus BJIs (orthopedic device-related infections, 69 %; methicillin-resistance, 17 %) were treated by teicoplanin at the initial dose of 5.7 mg/kg/day (IQR, 4.7-6.5) after a loading dose of 5 injections 12 h apart. The first trough teicoplanin level (Cmin) reached the therapeutic target (15 mg/L) in 26 % of patients, only. An overdose (Cmin>25 mg/L) was observed in 16 % patients, 50 % of which had chronic renal failure (p = 0.049). Seven adverse events occurred in 6 patients (10 %); no predictive factor could be highlighted. After a 91-week follow-up (IQR, 51-183), 27 treatment failures were observed (42 %), associated with diabetes (OR, 5.1; p = 0.057), systemic inflammatory disease (OR, 5.6; p = 0.043), and abscess (OR, 4.1; p < 10-3). A normal CRP-value at 1 month was protective (OR, 0.2; p = 0.029). Subcutaneous administration (n = 14) showed no difference in pharmacokinetics and tolerance compared to the intravenous route.


CONCLUSIONS
Teicoplanin constitutes a well-tolerated therapeutic alternative in S. aureus BJI, with a possible subcutaneous administration in outpatients. The loading dose might be increase to 9-12 mg/kg to quickly reach the therapeutic target, but tolerance of such higher doses remains to be evaluated, especially if using the subcutaneous route.
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.|Department of General Medicine, Claude Bernard Lyon 1 University, Lyon, France.
Olivier
O
Peeters
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
Tristan
T
Ferry
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
Florence
F
Ader
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
André
A
Boibieux
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
Evelyne
E
Braun
Department of Infectious Diseases, Lucien Hussel Hospital Center, Vienne, France.
Anissa
A
Bouaziz
Department of Infectious Diseases, William Morey Hospital Center, Châlon-sur-Saône, France.
Judith
J
Karsenty
Department of Infectious Diseases, Centre Hospitalier Métropole Savoie, Chambéry, France.
Emmanuel
E
Forestier
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.|Laboratory of Bacteriology, National Reference Center for Staphylococci, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Frédéric
F
Laurent
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.|Department of Orthopedic Surgery, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Sébastien
S
Lustig
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
Christian
C
Chidiac
Regional Referral Center for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France. florent.valour@chu-lyon.fr.|Infectious Disease Department, Hospices Civils de Lyon, Groupement Hospitalier Nord, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France. florent.valour@chu-lyon.fr.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France. florent.valour@chu-lyon.fr.
Florent
http://orcid.org/0000-0002-1467-6162
F
Valour
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D055104:Infusions, Subcutaneous; D007595:Joint Prosthesis; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus; D017334:Teicoplanin / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin
Bone and joint infection; Staphylococcus aureus; Subcutanous administration; Teicoplanin