Journal of Antimicrobial Chemotherapy, Vol 39, 145-151, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
PK Linden, AW Pasculle, D McDevitt and DJ Kramer
Serious infection with vancomycin-resistant Enterococcus faecium (VREF)
strains has no proven effective antimicrobial therapy. We compared the
clinical and bacteriological outcomes of 20 patients with VREF bacteraemia
treated with quinupristin/dalfopristin (RP 59500), an investigational
streptogramin, with a historical cohort of 42 patients with VREF
bacteraemia treated with other agents. Quinupristin/dalfopristin
demonstrated in-vitro bacteriostatic activity against all 20 initial VREF
blood isolates (MIC range 0.03-0.50 mg/L) by macrobroth dilution. The
clinical characteristics of both groups were comparable for major
outcome-dependent variables. There were five cases of recurrent VREF
bacteraemia in the quinupristin/dalfopristin- treated cohort and 21 in the
controls (P = 0.11); persistence of VREF at the primary site was found in
six and 18 of the evaluable patients with follow-up cultures in these two
cohorts (P = 0.06). In-hospital mortality was high in both groups: 65% in
the quinupristin/dalfopristin group and 52% in the control group; however,
VREF-associated mortality was significantly lower in the
quinupristin/dalfopristin group (five and 17 respectively; P = 0.05).
Follow-up susceptibility testing of five VREF isolates in the quinupristin/
dalfopristin group did not demonstrate resistance to
quinupristin/dalfopristin. Quinupristin/ dalfopristin may be a useful agent
for the therapy of serious VREF infection. Further clinical investigations
are warranted to confirm or refute its clinical efficacy.
ORIGINAL ARTICLES
Effect of quinupristin/dalfopristin on the outcome of vancomycin- resistant Enterococcus faecium bacteraemia: comparison with a control cohort
Department of Medicine, University of Pittsburgh Medical Center, PA, USA.
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