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Use of quinupristin/dalfopristin in a critical patient with a methicillin-resistant Staphilococcus aureus infection

E De Robertis1, D Viscidi, G Servillo

  • 1Department of Anesthesia and Intensive Care, Federico II University, Naples, Italy. ederober@unina.it

Minerva Anestesiologica
|November 2, 2004
PubMed

Insights

A patient with a severe methicillin-resistant Staphylococcus aureus infection, unresponsive to glycopeptide antibiotics, was successfully treated with quinupristin/dalfopristin. This case highlights the efficacy of streptogramins for difficult-to-treat Gram-positive infections.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Critical Care Medicine

Background:

  • Rising incidence of Gram-positive multidrug-resistant organisms necessitates novel therapeutic strategies.
  • Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant clinical challenge, often requiring alternative treatments.

Observation:

  • A 28-year-old male presented with sepsis due to MRSA, initially treated with teicoplanin and meropenem.
  • Despite initial improvement and extubation, the patient experienced persistent fever and leukocytosis with MRSA bacteremia.
  • The MRSA isolate demonstrated in vitro susceptibility to glycopeptides, yet the patient did not respond to glycopeptide therapy.

Findings:

  • Quinupristin/dalfopristin (a streptogramin) was added due to suspected glycopeptide non-response.
  • This combination therapy led to rapid clinical improvement, sepsis resolution, and microbiological sterilization.
  • The patient ultimately recovered and was discharged.

Implications:

  • Quinupristin/dalfopristin can be an effective treatment option for critical MRSA infections unresponsive to standard therapies.
  • This case underscores the importance of considering alternative antibiotics when patients do not respond to initial treatments, even with in vitro susceptibility.
  • Further research into the role of streptogramins in managing multidrug-resistant Gram-positive infections is warranted.

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