Ng John, Gosbell Iain B
Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool, New South Wales, Australia.
J Antimicrob Chemother. 2005 Jun;55(6):1008-12. doi: 10.1093/jac/dki108. Epub 2005 Apr 21.
Oral treatment regimens for multiresistant methicillin-resistant Staphylococcus aureus (MRSA) infections are limited. In Australia, rifampicin plus fusidic acid is the usual treatment regimen following glycopeptide therapy but many patients are intolerant of this; some isolates are resistant; new oxazolidinones are expensive for routine use. Pristinamycin is a possible alternative and we report our experience with this agent.
The Department of Microbiology and Infectious Diseases, South Western Area Pathology Service treats patients drawn from the South Western Sydney Area Health Service that houses approximately 800,000 people and contains approximately 2000 acute care public hospital beds. Patients prescribed pristinamycin between 1 September 2000 and 31 January 2000 were identified from hospital pharmacy records. A retrospective chart review was performed. Accepted clinical definitions of osteomyelitis and septic arthritis were used.
Twenty-seven patients were identified with osteoarticular infections. Twenty-four cases involved Staphylococcus aureus (multiresistant MRSA in 21 cases); three involved Staphylococcus epidermidis sensu stricto; four cases involved multiple organisms. Nineteen cases received pristinamycin monotherapy; the others received various combinations (fusidic acid with five; other antibiotics with three). Therapy was generally well tolerated; no haematological or biochemical toxicity was detected. Seven patients had minor gastrointestinal disturbance; and one developed rash. Four patients required dose reduction. Only four patients ceased pristinamycin due to intolerance. Treatment outcome was evaluated in 23 cases; cure was effected in 16 cases, five were successfully suppressed and two failed. There were no deaths.
Oral pristinamycin is well tolerated and an important additional agent to treat osteoarticular infections with multiresistant MRSA and other staphylococci.
耐多药耐甲氧西林金黄色葡萄球菌（MRSA）感染的口服治疗方案有限。在澳大利亚，利福平加夫西地酸是糖肽类治疗后的常用治疗方案，但许多患者对此不耐受；一些分离株耐药；新型恶唑烷酮类用于常规治疗费用昂贵。 pristinamycin是一种可能的替代药物，我们报告了使用该药物的经验。
西南地区病理服务部微生物与传染病科治疗来自西南悉尼地区卫生服务中心的患者，该中心服务约80万人，拥有约2000张急性护理公立医院床位。从医院药房记录中识别出2000年9月1日至2000年1月31日期间开具pristinamycin处方的患者。进行了回顾性病历审查。采用了公认的骨髓炎和化脓性关节炎临床定义。
确定27例患者患有骨关节炎感染。24例涉及金黄色葡萄球菌（21例为耐多药MRSA）；3例涉及狭义表皮葡萄球菌；4例涉及多种微生物。19例接受pristinamycin单药治疗；其他患者接受了各种联合治疗（夫西地酸联合5例；其他抗生素联合3例）。治疗一般耐受性良好；未检测到血液学或生化毒性。7例患者有轻微胃肠道不适；1例出现皮疹。4例患者需要减量。只有4例患者因不耐受而停用pristinamycin。对23例患者的治疗结果进行了评估；16例治愈，5例得到成功控制，2例治疗失败。无死亡病例。
口服pristinamycin耐受性良好，是治疗耐多药MRSA和其他葡萄球菌引起的骨关节炎感染的重要补充药物。
