Efrén Sánchez Vidal, Infectious Diseases Department, Complejo Hospitalario Universitario A Coruña, Calle As Xubias, 84. 15006. A Coruña (A Coruña). Spain.
Rev Esp Quimioter. 2021 Apr;34(2):115-119. doi: 10.37201/req/119.2020. Epub 2021 Feb 15.
To determine the indications, success rate and adverse effects of ceftaroline fosamil treatment in a tertiary hospital.
In total, 84 cases from February 2018 to December 2019 were retrospectively analysed. No exclusion criteria were applied.
Eighty-four patients, with a median age of 70 years, of which, 6.7% (56) were male, were treated with ceftaroline fosamil for a median of 14 days. Most indications were off-label, including 29 endocarditis (34.5%), 14 bacteraemia (16.6%), 5 Central nervous system (CNS) infections (6%) and 19 osteoarticular infections (22.6%). Staphylococcus aureus was the most frequently isolated microorganism, including 28 methicillin-sensitive S. aureus (MSSA; 33.3%) and 14 methicillin-resistant S. aureus (MRSA; 16.7%), followed by coagulase-negative Staphylococcus (23, 27.4%). The main reason for ceftaroline fosamil prescription was the failure of previous treatment (41.7% of cases). Treatment was successful in 60/84 patients (71.4%) and failed clinically or microbiologically in 14 (16.7%). Eight patients died for a reason not related to the infection and two were found to have a non-infectious condition. Twenty-two of thirty-five (62.8%) patients prescribed ceftaroline because of failure of previous treatment improved, including eight endocarditis and seven bacteraemia. Adverse effects were reported in five patients (5.9%) including neutropenia, thrombocytopenia, transaminases elevation and creatinine elevation; all except one were mild and all resolved after discontinuation of treatment.
Ceftaroline fosamil is a well-tolerated cephalosporine, effective against multi- resistant gram-positive and many gram-negative microorganisms. Our experience suggests that it is effective as a rescue or first-line therapy in other indications than those currently approved.
确定头孢洛林治疗在一家三级医院的适应证、成功率和不良反应。
回顾性分析 2018 年 2 月至 2019 年 12 月期间的 84 例患者。未应用排除标准。
84 例患者中位年龄为 70 岁，其中 6.7%（56 例）为男性，使用头孢洛林治疗的中位时间为 14 天。大多数适应证为超适应证，包括 29 例心内膜炎（34.5%）、14 例菌血症（16.6%）、5 例中枢神经系统（CNS）感染（6%）和 19 例骨关节炎感染（22.6%）。金黄色葡萄球菌是最常分离的微生物，包括 28 株甲氧西林敏感金黄色葡萄球菌（MSSA；33.3%）和 14 株耐甲氧西林金黄色葡萄球菌（MRSA；16.7%），其次是凝固酶阴性葡萄球菌（23 株，27.4%）。使用头孢洛林的主要原因是先前治疗失败（41.7%的病例）。84 例患者中 60 例（71.4%）治疗成功，14 例临床或微生物学治疗失败。8 例患者因与感染无关的原因死亡，2 例患者发现非传染性疾病。因先前治疗失败而使用头孢洛林的 35 例患者中有 22 例（62.8%）得到改善，包括 8 例心内膜炎和 7 例菌血症。5 例（5.9%）患者报告了不良反应，包括中性粒细胞减少症、血小板减少症、转氨酶升高和肌酐升高；除 1 例外，所有不良反应均为轻度，停药后均得到缓解。
头孢洛林是一种耐受良好的头孢菌素，对多种耐药革兰阳性和许多革兰阴性微生物有效。我们的经验表明，它作为其他适应证的挽救或一线治疗药物，效果良好，这些适应证目前尚未得到批准。
