Matsuda Kensuke, Koya Junji, Toyama Kazuhiro, Ikeda Mahoko, Arai Shunya, Nakamura Fumihiko, Okugawa Shu, Moriya Kyoji, Kurokawa Mineo
Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Infect Chemother. 2017 Nov;23(11):788-790. doi: 10.1016/j.jiac.2017.06.010. Epub 2017 Jul 23.
Antibiotic-resistant infections remain to be a major issue for all over the world. Although appropriate diagnosis and rapid treatment initiation are crucially important particularly in immunocompromised patients, selection of antibiotics without identification of causative bacteria is often challenging. A 44-year-old woman with acute myeloid leukemia (AML) under myelosuppression suffered from teicoplanin-resistant gram-positive cocci bacteremia. Taking severe neutropenia due to chemotherapy and glycopeptide-resistance into account, teicoplanin was empirically substituted with daptomycin, which led to prompt defervescence. This microorganism later turned out to be Leuconostoc lactis (L. Lactis), and daptmycin was continued to use based on antimicrobial susceptibility tests. As a result, empiric use of daptomycin successfully controlled glycopeptide-resistant gram-positive cocci bacteremia under neutropenia. This is the first report of daptomycin treatment for L. lactis bacteremia in a patient with AML under neutropenia. Our findings suggest that daptomycin would be a suitable treatment option for glycopeptide-resistant gram-positive cocci bloodstream infections, especially in myelosuppressive patients.
抗生素耐药性感染仍然是全球面临的一个主要问题。尽管进行恰当诊断并迅速开始治疗至关重要，尤其是对于免疫功能低下的患者，但在未鉴定出致病细菌的情况下选择抗生素往往具有挑战性。一名44岁处于骨髓抑制期的急性髓系白血病（AML）女性患者患上了对替考拉宁耐药的革兰氏阳性球菌菌血症。考虑到化疗导致的严重中性粒细胞减少症以及糖肽类耐药性，经验性地将替考拉宁换为达托霉素，这使得患者迅速退热。后来发现该微生物为乳酸乳球菌，基于药敏试验继续使用达托霉素。结果，经验性使用达托霉素成功控制了中性粒细胞减少症患者中对糖肽类耐药的革兰氏阳性球菌菌血症。这是关于达托霉素治疗中性粒细胞减少的AML患者乳酸乳球菌菌血症的首例报告。我们的研究结果表明，达托霉素对于对糖肽类耐药的革兰氏阳性球菌血流感染将是一种合适的治疗选择，尤其是在骨髓抑制患者中。
