McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA.
Ann Pharmacother. 2013 Jul-Aug;47(7-8):e30. doi: 10.1345/aph.1S033. Epub 2013 May 28.
To describe a case in which a linezolid desensitization protocol was successfully used for a polymicrobial surgical wound infection in a patient with multiple drug hypersensitivity reactions.
A 24-year-old woman with vocal cord dysfunction requiring tracheostomy was admitted for a surgical wound infection following a tracheostomy fistula closure procedure. The patient reported multiple antibiotic allergies including penicillins (rash), sulfonamides (rash), vancomycin (anaphylaxis), azithromycin (rash), cephalosporins (anaphylaxis), levofloxacin (unspecified), clindamycin (unspecified), and carbapenems (unspecified). Gram stain of the purulent wound drainage demonstrated mixed gram-negative and gram-positive flora, and bacterial cultures were overgrown with Proteus mirabilis, which precluded identification of other pathogens. Following failed test doses of linezolid, tigecycline, and daptomycin, all of which resulted in hypersensitivity reactions, a 16-step linezolid desensitization protocol was developed and successfully implemented without adverse reactions. The patient completed a 2-week course of antibiotic therapy that included linezolid upon finishing the desensitization protocol.
Linezolid is useful in treating complicated and uncomplicated skin and soft tissue infections caused by gram-positive bacteria. With precautions, including premedication, a monitored nursing unit, and immediate availability of an emergency anaphylaxis kit, drug desensitization allows patients the ability to safely use medications to which they may have an immediate hypersensitivity reaction. Minimal data exist on linezolid desensitization protocols.
Linezolid desensitization can be a viable option in patients requiring antimicrobial therapy for complicated gram-positive skin infections.
描述一例利奈唑胺脱敏方案成功用于治疗一位多种药物过敏反应患者的多发性微生物手术伤口感染的病例。
一位 24 岁女性因声带功能障碍需要行气管切开术，在气管切开瘘闭合术后发生手术伤口感染。该患者报告有多种抗生素过敏史，包括青霉素（皮疹）、磺胺类药物（皮疹）、万古霉素（过敏反应）、阿奇霉素（皮疹）、头孢菌素（过敏反应）、左氧氟沙星（未特指）、克林霉素（未特指）和碳青霉烯类（未特指）。脓性伤口引流的革兰氏染色显示混合革兰氏阴性和革兰氏阳性菌群，细菌培养物被奇异变形杆菌过度生长，无法鉴定其他病原体。在利奈唑胺、替加环素和达托霉素的测试剂量失败后，所有这些药物均导致过敏反应，因此制定并成功实施了 16 步利奈唑胺脱敏方案，没有不良反应。患者在完成脱敏方案后，完成了为期 2 周的抗生素治疗，包括利奈唑胺。
利奈唑胺可有效治疗由革兰氏阳性菌引起的复杂和非复杂性皮肤和软组织感染。通过预防措施，包括预用药、监测护理单元和紧急过敏反应套件的即时可用性，药物脱敏使患者能够安全使用可能会产生即刻过敏反应的药物。关于利奈唑胺脱敏方案的数据很少。
对于需要抗微生物治疗复杂革兰氏阳性皮肤感染的患者，利奈唑胺脱敏可能是一种可行的选择。
