Carrie L. Griffiths, Pharm.D., is Assistant Professor, Pharmacist, Wingate University School of Pharmacy (WUSOP), Wingate, NC, and Critical Care Clinical Pharmacist, Department of Pharmacy, Carolinas Medical Center, Charlotte, NC. Kristofer C. Gutierrez is Pharm.D. student; and Renee D. Pitt is Pharm.D. student, WUSOP. Roger D. Lovell, M.D., FACP, is Infectious Disease Physician and Clinical Professor, Department of Internal Medicine, University of North Carolina School of Medicine, Charlotte.
Am J Health Syst Pharm. 2014 Mar 1;71(5):403-6. doi: 10.2146/ajhp130441.
A case of eosinophilic pneumonia in a patient receiving ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is reported.
A 65-year-old woman was admitted to a medical intensive care unit after arriving at the emergency room with complaints of progressively worsening shortness of breath. Her medical history included chronic obstructive pulmonary disease, acute respiratory distress syndrome, recent traumatic brain injury, tobacco use, and alcohol abuse. Within the first few days of hospitalization, the patient was diagnosed with MRSA pneumonia based on microbiological data from bronchoscopy bronchial washings. Her renal function liver enzyme levels were within normal limits. Empirical antibiotic therapy included i.v. vancomycin and meropenem and was narrowed to i.v. linezolid monotherapy based on culture and sensitivity results. After 10 days of treatment with linezolid, the patient was persistently febrile, and cultures remained positive. It was decided to switch therapy to a course of i.v. ceftaroline, an anti-MRSA cephalosporin. On the fifth day of treatment with ceftaroline, the patient developed respiratory decompensation and peripheral eosinophilia of 40%. Bronchoalveolar lavage (BAL) results indicated the presence of pulmonary eosinophilia of 13%. Chest radiographs revealed pulmonary infiltrates, and the computed tomography angiography showed no evidence of pulmonary embolism. Ceftaroline was discontinued, and the patient was started on vancomycin and methylprednisolone. The patient responded to methylprednisolone therapy, with repeat BAL and peripheral blood counts showing resolved eosinophilia.
A patient with risk factors for respiratory disease developed eosinophilic pneumonia after receiving ceftaroline for the treatment of MRSA pneumonia. Eosinophilia resolved after ceftaroline was discontinued and i.v. methylprednisolone was initiated.
报告 1 例接受头孢洛林治疗耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的患者发生嗜酸性肺炎。
一名 65 岁女性因进行性呼吸急促恶化到急诊室就诊后被收入重症监护病房。她的病史包括慢性阻塞性肺疾病、急性呼吸窘迫综合征、近期创伤性脑损伤、吸烟和酗酒。在住院的最初几天，根据支气管镜支气管灌洗的微生物学数据，该患者被诊断为 MRSA 肺炎。她的肾功能和肝酶水平均在正常范围内。经验性抗生素治疗包括静脉万古霉素和美罗培南，并根据培养和药敏结果窄谱至静脉注射利奈唑胺单药治疗。利奈唑胺治疗 10 天后，患者仍持续发热，培养结果仍为阳性。决定将治疗方案转换为静脉注射头孢洛林，一种抗 MRSA 头孢菌素。在使用头孢洛林治疗的第 5 天，患者出现呼吸失代偿和外周血嗜酸性粒细胞计数 40%。支气管肺泡灌洗（BAL）结果表明存在肺部嗜酸性粒细胞增多 13%。胸部 X 线片显示肺部浸润，计算机断层血管造影术未显示肺栓塞证据。停用头孢洛林，给予患者万古霉素和甲基强的松龙。患者对甲基强的松龙治疗有反应，重复 BAL 和外周血计数显示嗜酸性粒细胞增多已缓解。
患有呼吸疾病危险因素的患者在接受头孢洛林治疗 MRSA 肺炎后发生嗜酸性肺炎。停用头孢洛林并开始静脉注射甲基强的松龙后，嗜酸性粒细胞增多得到缓解。
