Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
First Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
J Clin Pharm Ther. 2020 Dec;45(6):1342-1348. doi: 10.1111/jcpt.13215. Epub 2020 Jul 13.
Our previous report indicated that teicoplanin (TEIC) caused fewer adverse effects than vancomycin (VCM) in patients with febrile neutropenia (FN) receiving haematopoietic stem cell transplantation (HSCT). However, we observed breakthrough methicillin-resistant-Staphylococcus haemolyticus (MR-S haemolyticus) infection during TEIC therapy in these patients. In this study, we sought to compare the incidence of breakthrough Gram-positive cocci (GPC) infection during VCM and TEIC therapy in this population.
A single-centre, retrospective cohort study was conducted. Patients who had received HSCT and were administered VCM (n = 19) or TEIC (n = 38) for FN from 1 September 2011 to 31 August 2019 were enrolled. We compared the incidence of breakthrough GPC infection between the VCM and TEIC groups.
Breakthrough GPC infection during glycopeptide therapy in febrile neutropenic patients received HSCT was observed in three patients (7.9%) in the TEIC group but in none of patients (0%) in the VCM group. MR-S haemolyticus with low glycopeptide susceptibility (TEIC MIC = 2-8 μg/mL, VCM MIC = 2-4 μg/mL) was isolated from blood cultures in all patients with breakthrough GPC infections. All breakthrough infections were cured by changing from TEIC to daptomycin (DAP).
The incidence of breakthrough GPC infection during glycopeptide therapy in febrile neutropenic HSCT patients was higher in the TEIC group than in the VCM group. MR-S haemolyticus with low glycopeptide susceptibility was isolated from all patients with breakthrough GPC infection and successfully treated with DAP.
我们之前的报告表明，在接受造血干细胞移植（HSCT）的发热性中性粒细胞减少症（FN）患者中，替考拉宁（TEIC）比万古霉素（VCM）引起的不良反应更少。然而，我们在这些患者的 TEIC 治疗中观察到了突破耐甲氧西林溶血葡萄球菌（MR-S 溶血葡萄球菌）感染。在这项研究中，我们试图比较 VCM 和 TEIC 治疗在该人群中突破革兰阳性球菌（GPC）感染的发生率。
进行了一项单中心、回顾性队列研究。纳入 2011 年 9 月 1 日至 2019 年 8 月 31 日期间因 FN 接受 HSCT 并接受 VCM（n=19）或 TEIC（n=38）治疗的患者。我们比较了 VCM 和 TEIC 组中突破性 GPC 感染的发生率。
TEIC 组中有 3 名（7.9%）发热性中性粒细胞减少症患者在接受 HSCT 时在糖肽治疗期间发生突破性 GPC 感染，而 VCM 组中无患者（0%）发生突破性 GPC 感染。所有突破性感染均通过从 TEIC 改为达托霉素（DAP）治愈。
在接受 HSCT 的发热性中性粒细胞减少症患者中，TEIC 组糖肽治疗期间突破性 GPC 感染的发生率高于 VCM 组。所有突破性 GPC 感染患者均从血液培养中分离出低糖肽敏感性的溶血葡萄球菌（TEIC MIC=2-8μg/mL，VCM MIC=2-4μg/mL），并用 DAP 成功治愈。
