Aspinall S L, Friedland D M, Yu V L, Rihs J D, Muder R R
Pharmacy Service, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA.
Ann Pharmacother. 1995 Jul-Aug;29(7-8):694-7. doi: 10.1177/106002809502907-807.
To report on a patient with recurrent methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bacteremia successfully treated with combination antibiotic therapy.
Two sets of blood cultures from a 55-year-old man with fever, malaise, and low back pain grew MRSA. Radiologic studies of the spine showed bony changes consistent with osteomyelitis. Soon after completing 6 weeks of vancomycin, the patient experienced a recurrence of back pain. Laboratory values included an increase in the sedimentation rate to 53 mm/h and positive blood cultures for MRSA. Vancomycin, gentamicin, and rifampin were administered for 8 weeks. Serum inhibitory and bactericidal titers were more than 1:1024 for both the peak and trough concentrations. Radiologic studies of the spine showed healing osteomyelitis. Two years after completion of antibiotic therapy, the infection has not recurred.
Antibiotic therapy alone was attempted because the patient was considered a risky surgical candidate. Serum inhibitory and bactericidal titers documented the high in vivo activity of the vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin therapy led to disappearance of the fever and back pain. Cure was documented by sustained normalization of the erythrocyte sedimentation rate and radiologic evidence of healing.
Combination antibiotic therapy with vancomycin, rifampin, and low-dose gentamicin (1 mg/kg q12h) may be useful for deep-seated tissue infection caused by MRSA.
报告一例复发性耐甲氧西林金黄色葡萄球菌（MRSA）骨髓炎和菌血症患者经联合抗生素治疗成功治愈的病例。
一名55岁男性，有发热、乏力和腰痛症状，两套血培养结果均为MRSA生长。脊柱影像学检查显示骨质改变符合骨髓炎表现。在完成6周万古霉素治疗后不久，患者再次出现背痛。实验室检查结果包括血沉升至53mm/h以及MRSA血培养阳性。给予万古霉素、庆大霉素和利福平治疗8周。血清抑菌和杀菌效价在峰值和谷值浓度时均超过1:1024。脊柱影像学检查显示骨髓炎愈合。抗生素治疗完成两年后，感染未复发。
由于该患者被认为是手术高危候选人，因此首先尝试单独使用抗生素治疗。血清抑菌和杀菌效价证明了万古霉素、庆大霉素和利福平联合用药在体内具有较高活性。开始使用万古霉素治疗后，发热和背痛症状消失。红细胞沉降率持续正常化以及影像学愈合证据证明了治愈。
万古霉素、利福平与低剂量庆大霉素（1mg/kg，每12小时一次）联合抗生素治疗可能对MRSA引起的深部组织感染有效。
