Buonomo A R, Cattaneo L, Viceconte G, Calabria F, Di Troia G, Di Fusco A, Mula J, Cozzolino A, Ametrano L, D'Avolio A, Gentile I
Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini, 5, 80131 Naples, Italy.
Department of Medical Sciences, Laboratory of Clinical Pharmacology and Pharmacogenetics, University of Turin, Amedeo Di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
IDCases. 2024 Oct 31;38:e02105. doi: 10.1016/j.idcr.2024.e02105. eCollection 2024.
Oritavancin is a novel long-acting lipoglycopeptide with in vitro activity against methicillin-resistant (MR) Gram-positive pathogens and a good bactericidal activity even in presence of biofilm forming bacteria. It has been approved for acute bacterial skin and skin structure infections (ABSSSI), but recent reports have demonstrated possible off-label uses, as for prosthetic joint infections (PJI), which, in more than half of cases, are caused by MR Gram positive organisms. W reported a case of a man in his eighties with a late shoulder PJI caused by methicillin resistant (MRSE) with contraindications for surgical replacement and few oral therapeutic options for a long term suppressive antibiotic therapy. The prosthesis was retained, and the patient received ten outpatient sequential doses of 1200 mg of oritavancin for 28 weeks, based on therapeutic drug monitoring (TDM) as a guide for correct timing of administration of each dose. During oritavancin administration, the patient achieved clinical cure, with disappearance of the pain and regaining pre-infection joint mobility, with no side effects reported and no further surgery or hospitalization needed. The treatment is ongoing as a long-lasting suppressive antimicrobial therapy. Oritavancin could represent an excellent solution for treating PJI caused by MR organism, especially in patients who need a long-term suppressive therapy.
奥利万星是一种新型长效脂糖肽，对耐甲氧西林（MR）革兰氏阳性病原体具有体外活性，即使在存在形成生物膜的细菌时也具有良好的杀菌活性。它已被批准用于治疗急性细菌性皮肤和皮肤结构感染（ABSSSI），但最近的报告显示它可能存在一些未获批准的用途，如用于治疗人工关节感染（PJI），在超过一半的病例中，这种感染是由MR革兰氏阳性菌引起的。我们报告了一例八十多岁男性患者，患有由耐甲氧西林金黄色葡萄球菌（MRSE）引起的晚期肩部人工关节感染，存在手术置换的禁忌症，且长期抑制性抗生素治疗的口服治疗选择有限。保留了假体，患者根据治疗药物监测（TDM）作为每次给药正确时间的指导，接受了10次门诊序贯剂量的1200毫克奥利万星治疗，为期28周。在奥利万星给药期间，患者实现了临床治愈，疼痛消失，恢复了感染前的关节活动度，未报告有副作用，也无需进一步手术或住院治疗。作为一种长期的抑制性抗菌治疗，该治疗仍在进行中。奥利万星可能是治疗由MR菌引起的人工关节感染的极佳解决方案，特别是对于需要长期抑制性治疗的患者。
