Valour Florent, Boibieux André, Karsenty Judith, Vallat Marie-Paule, Braun Evelyne, Perpoint Thomas, Biron François, Laurent Frédéric, Lustig Sébastien, Chidiac Christian, Ferry Tristan
Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
J Antimicrob Chemother. 2016 Apr;71(4):1063-70. doi: 10.1093/jac/dkv457. Epub 2016 Jan 21.
The aim of this study was to evaluate pristinamycin in the treatment of MSSA bone and joint infection (BJI).
A retrospective, single-centre cohort study (2001-11) investigated outcome in adults receiving pristinamycin for MSSA BJI and pristinamycin-related adverse events (AEs).
One hundred and two MSSA BJIs were assessed in 98 patients [chronic infection, 33.3%; and orthopaedic device-related infection (ODI), 67.6%]. Surgery was performed in 77.5% of total cases, and in all but three ODIs, associated with antibiotic therapy of a median total duration of 29.2 weeks. Pristinamycin was prescribed as a part of the initial intensive treatment phase (29.4%) and/or included in final maintenance therapy (83.3%) at a dose of 47.6 (45.5-52.6) mg/kg/day for 9.3 (1.4-20.4) weeks. AEs occurred in 13.3% of patients, consisting of gastrointestinal disorder (76.9%) or allergic reaction (23.1%), leading to treatment interruption in 11 cases. AEs were related to daily dose (OR, 2.733 for each 10 additional mg/kg/day; P = 0.049). After a follow-up of 76.4 (29.6-146.9) weeks, the failure rate was 34.3%, associated with ODI (OR, 4.421; P = 0.006), particularly when the implant was retained (OR, 4.217; P = 0.007). In most patients, the pristinamycin companion drug was a fluoroquinolone (68.7%) or rifampicin (21.7%), without difference regarding outcome.
Pristinamycin is an effective, well-tolerated alternative therapeutic option in MSSA BJI, on condition that a daily dosage of 50 mg/kg is respected.
本研究旨在评估 pristinamycin（普里西他霉素）治疗甲氧西林敏感金黄色葡萄球菌（MSSA）骨与关节感染（BJI）的效果。
一项回顾性单中心队列研究（2001 年至 2011 年）调查了接受 pristinamycin 治疗 MSSA BJI 的成人患者的治疗结果以及与 pristinamycin 相关的不良事件（AE）。
对 98 例患者的 102 例 MSSA BJI 进行了评估[慢性感染占 33.3%；骨科器械相关感染（ODI）占 67.6%]。77.5%的病例进行了手术，除 3 例 ODI外，所有病例均接受了抗生素治疗，抗生素治疗的中位总疗程为 29.2 周。Pristinamycin 被用作初始强化治疗阶段的一部分（29.4%）和/或包含在最终维持治疗中（83.3%），剂量为 47.6（45.5 - 52.6）mg/kg/天，持续 9.3（1.4 - 20.4）周。13.3%的患者出现不良事件，包括胃肠道疾病（76.9%）或过敏反应（23.1%），导致 11 例患者治疗中断。不良事件与每日剂量相关（每增加 10mg/kg/天，OR 为 2.733；P = 0.049）。经过 76.4（29.6 - 146.9）周的随访，失败率为 34.3%，与 ODI 相关（OR 为 4.421；P = 0.006），特别是当植入物保留时（OR 为 4.217；P = 0.007）。在大多数患者中，pristinamycin 的联合用药是氟喹诺酮类药物（68.7%）或利福平（21.7%），在治疗结果方面无差异。
普里西他霉素是治疗 MSSA BJI 的一种有效且耐受性良好的替代治疗选择，但前提是要遵守每日 50mg/kg 的剂量。
