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Treatment of Multidrug-Resistant Vancomycin-Resistant Enterococcus faecium Hardware-Associated Vertebral

Samira Dahesh1, Brian Wong2, Victor Nizet1,3

  • 1University of California San Diego School of Medicine, La Jolla, California, USA.

Antimicrobial Agents and Chemotherapy
|June 26, 2019
PubMed

Insights

Weekly oritavancin and ampicillin combination therapy successfully treated a deep spine infection caused by vancomycin-resistant Enterococcus faecium. Synergy was confirmed in vitro, with further potential synergies identified.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Microbiology

Background:

  • Deep spine infections pose significant treatment challenges, particularly those caused by multidrug-resistant organisms.
  • Vancomycin-resistant Enterococcus faecium (VRE) is a problematic pathogen in healthcare-associated infections.
  • Novel therapeutic strategies are needed to combat resistant bacterial infections.

Observation:

  • A patient with a deep spine infection due to vancomycin-resistant Enterococcus faecium (VRE) associated with hardware was treated.
  • The treatment regimen involved weekly oritavancin plus ampicillin administered via continuous infusion.
  • In vitro assays were performed to evaluate the antimicrobial activity of the combination therapy.

Findings:

  • The combination therapy of weekly oritavancin and ampicillin successfully treated the deep spine VRE infection.
  • Checkerboard and time-kill assays demonstrated synergistic activity between oritavancin and ampicillin.
  • Additional synergistic effects were observed when oritavancin and ampicillin were combined with rifampin or cathelicidin LL-37.

Implications:

  • This study highlights a potential effective treatment strategy for challenging VRE spine infections.
  • The demonstrated in vitro synergy supports further investigation into oritavancin-based combination therapies.
  • Identifying synergistic partners like rifampin or LL-37 could lead to enhanced treatment options for resistant infections.
Keywords:
ampicillinoritavancinvancomycin-resistant Enterococcus faecium

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