Baystate Medical Center, Department of Pharmacy, Springfield, MA, USA.
Department of Medicine, University of Massachusetts Medical School-Baystate, Division of Infectious Disease, Springfield, MA, USA.
J Infect Chemother. 2022 Mar;28(3):465-468. doi: 10.1016/j.jiac.2021.12.022. Epub 2022 Jan 10.
Dalbavancin is a lipoglycopeptide antibiotic used off-label to treat serious gram-positive infections, including infections secondary to methicillin-resistant Staphylococcus aureus (MRSA). Dalbavancin has unique pharmacokinetic parameters and has a role in therapy for treating vulnerable patients, including intravenous drug users, who have challenges complying with typical care plans for serious infections. While there is data indicating successful clinical use of dalbavancin in patients with history of intravenous drug use as well as pharmacokinetic-pharmacodynamic data assessing dalbavancin in obesity, there is a lack of information regarding clinical effects of dalbavancin in patients with extreme obesity, especially in patients with concomitant drug use. This case report describes a 40-year-old morbidly obese female actively using intravenous drugs who developed prolonged MRSA bacteremia without a recognizable focus. Despite partial treatment with dalbavancin, the patient developed osteomyelitis and discitis of the spine with associated epidural phlegmon, likely complications of the MRSA bacteremia.
达巴万星是一种糖肽类抗生素，被超说明书用于治疗严重的革兰氏阳性感染，包括耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染。达巴万星具有独特的药代动力学参数，在治疗包括静脉药物使用者在内的易感染患者方面具有作用，这些患者在遵守严重感染的典型治疗方案方面存在挑战。虽然有数据表明达巴万星在有静脉药物使用史的患者中具有成功的临床应用，也有药代动力学-药效学数据评估肥胖患者中的达巴万星，但对于极度肥胖患者，特别是合并药物使用的患者中，达巴万星的临床效果信息有限。本病例报告描述了一名 40 岁的病态肥胖女性，正在积极使用静脉药物，她患有持续性 MRSA 菌血症，且无明显病灶。尽管部分使用了达巴万星治疗，但患者仍发展为骨髓炎和脊柱椎间盘炎，伴有硬膜外脓性痰，可能是 MRSA 菌血症的并发症。
