Butin M, Claris O, Laurent F
Service de néonatologie et réanimation néonatale, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France; Équipe « Pathogénèse des infections à Staphylocoques », Inserm U1111, centre international de recherche en infectiologie, 46, allée d'Italie, 69364 Lyon cedex 07, France.
Service de néonatologie et réanimation néonatale, hospices civils de Lyon, hôpital femme-mère-enfant, 59, boulevard Pinel, 69677 Bron cedex, France; EA 4129, université Claude-Bernard, boulevard du 11-novembre-1918, 69100 Villeurbanne, France.
Arch Pediatr. 2019 May;26(4):236-237. doi: 10.1016/j.arcped.2019.03.002. Epub 2019 Apr 4.
Heteroresistance to vancomycin (HRV) represents a decreased susceptibility to vancomycin and is frequently observed in multidrug-resistant coagulase-negative staphylococci. The clinical significance of such heteroresistance is controversial, but several failures of vancomycin therapy have been related to HRV, especially in the neonatal population. Here we report the case of a preterm neonate, born at 26 weeks of gestation, who developed sepsis due to a multidrug-resistant HRV Staphylococcuscapitis isolate. Bacteremia persisted despite adequate vancomycin serum concentration and catheter removal. The patient finally recovered after replacing vancomycin by linezolid. Through this case report, we would like to alert clinicians of the potential clinical impact of HRV and to discuss the lack of therapeutic alternatives in neonates.
对万古霉素的异质性耐药（HRV）表现为对万古霉素的敏感性降低，且在多重耐药凝固酶阴性葡萄球菌中经常观察到。这种异质性耐药的临床意义存在争议，但万古霉素治疗的几次失败都与HRV有关，尤其是在新生儿群体中。在此，我们报告一例妊娠26周出生的早产儿病例，该患儿因一株多重耐药的HRV头状葡萄球菌分离株而发生败血症。尽管万古霉素血清浓度足够且拔除了导管，但菌血症仍持续存在。在用利奈唑胺替代万古霉素后，患者最终康复。通过本病例报告，我们希望提醒临床医生注意HRV的潜在临床影响，并讨论新生儿缺乏治疗替代方案的问题。
