达托霉素引起的急性血管性水肿。
Acute Angioedema Triggered by Daptomycin.
机构信息
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Clinical Pharmacology and Regional Pharmacovigilance Center, Bern University Hospital, University of Bern, Bern, Switzerland.
出版信息
Infect Dis Ther. 2016 Jun;5(2):201-5. doi: 10.1007/s40121-016-0111-4. Epub 2016 May 26.
INTRODUCTION
Daptomycin is a cyclic lipopeptide antibiotic, frequently administered for Staphylococcus aureus bloodstream infections. Numerous studies have shown that daptomycin is relatively safe and well tolerated. Serious adverse events possibly related to this antimicrobial compound are rare. We report a case of acute angioedema triggered by daptomycin.
CASE REPORT
A 60-year-old woman with S. aureus bacteremia without identified source was treated intravenously with high-dose beta-lactams at our institution. Because S. aureus bacteremia persisted on day 6, and in parallel, acute kidney injury developed, antimicrobial treatment was switched to a combination therapy with daptomycin and ceftriaxone. Shortly after completion of the first daptomycin administration, the patient developed lip and tongue swelling and dyspnea. Acute angioedema was clinically evident. Antibiotic therapy was switched to vancomycin, and the further clinical course was favorable. An intradermal test showed a significant wheal diameter for daptomycin, but negative results for ceftriaxone.
CONCLUSION
The association with daptomycin in this case is either probable or certain. Clinicians should be aware that daptomycin can cause immediate-type hypersensitivity reactions, including acute angioedema, even upon first administration.
简介
达托霉素是一种环状脂肽类抗生素，常用于治疗金黄色葡萄球菌血流感染。大量研究表明，达托霉素相对安全且耐受性良好。与这种抗菌化合物相关的严重不良事件很少见。我们报告了一例由达托霉素引起的急性血管性水肿病例。
病例报告
一名 60 岁女性患有金黄色葡萄球菌菌血症，未发现明确的感染源，在我院接受高剂量β-内酰胺类药物静脉治疗。由于第 6 天金黄色葡萄球菌菌血症仍未缓解，且同时发生急性肾损伤，因此将抗菌治疗方案更换为达托霉素和头孢曲松联合治疗。在第一次使用达托霉素后不久，患者出现嘴唇和舌头肿胀及呼吸困难。临床明显表现为急性血管性水肿。将抗生素治疗方案更换为万古霉素，随后患者的临床状况好转。皮内试验显示达托霉素的风团直径显著，而头孢曲松的皮试结果为阴性。
结论
在本例中，达托霉素与该反应的关联性为很可能或确定。临床医生应注意，达托霉素甚至在首次给药时也可能引起即刻型超敏反应，包括急性血管性水肿。
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