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Successful treatment of a neonate with persistent vancomycin-resistant enterococcal bacteremia with a daptomycin-containing regimen.

Beneri CA, Nicolau DP, Seiden HS, Rubin LG - Infect Drug Resist (2008)

Bottom Line: Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted.It was not cleared until daptomycin (in combination with doxycycline) was started.This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infectious Diseases, Schneider Children's Hospital - North Shore-LIJ Health System, New Hyde Park, New York, USA;

ABSTRACT
Infections caused by vancomycin-resistant enterococci (VRE) may be difficult to treat because of the limited armamentarium of antimicrobial agents. The difficulty is compounded in pediatric patients in general and neonates in particular because many of the newer antimicrobials have not been studied or approved for children. We report a 3-week-old infant who developed enterococcal bacteremia on post-operative day 10 after a surgical palliation for complex congenital heart disease that was complicated by acute renal failure. Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted. It was not cleared until daptomycin (in combination with doxycycline) was started. This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.

No MeSH data available.


Related in: MedlinePlus

Patient course in relation to blood culture results and antimicrobial therapy.Abbreviations: Va,vancomycin; Li, linezolid; Amp/Sulb, ampicillin/sulbactam; Quin/Dalfo,quinprisitin/dalfopristin; Rif, rifampin; Da, daptomycin
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f1-idr-1-009: Patient course in relation to blood culture results and antimicrobial therapy.Abbreviations: Va,vancomycin; Li, linezolid; Amp/Sulb, ampicillin/sulbactam; Quin/Dalfo,quinprisitin/dalfopristin; Rif, rifampin; Da, daptomycin

Mentions: At 11 days of age a full-term girl with hypoplastic left heart syndrome underwent Stage I Palliation (Norwood with Sano modification) with a 5 mm Gortex shunt placement. On post-operative day (POD) 10, she developed fever; blood cultures (BACTEC Peds-plus) were taken through a central venous catheter and via venipuncture followed by removal and replacement of vascular catheters. Vancomycin was empirically started (Figure 1). Both blood cultures grew Enterococcus species. Creatinine was 1.6 mg/dL. On POD 13 the blood culture isolates were identified as vancomycin-resistant Enterococcus faecium (VRE, susceptibilities in Table 1) and antimicrobial therapy was changed to linezolid (10 mg/kg/dose every 8 hours). On POD 15 she became afebrile but blood cultures remained positive through POD 18. On POD 16, all vascular catheters were removed and replaced. The antimicrobial was changed to quinupristin/dalfopristin (7.5 mg/kg/dose every 8 hours) on POD 18. Ampicillin-sulbactam (50 mg/kg/dose every 12 hours) was added a day later for possible synergy. The patient remained critically ill. On POD 18 the patient underwent cardiac catheterization; a restricted Sano shunt was found and a stent was placed with improvement. On POD 20 she became febrile. Blood cultures obtained on PODs 20, 21, 22, and 23 were negative, but blood cultures obtained on PODs 26, 29, and 30 grew VRE. On POD 30 the antimicrobial was changed to daptomycin at a dose of 4 mg/kg/dose every 48 hours (serum creatinine, 0.9 mg/dL) and rifampin (18 mg/kg/day). Blood cultures obtained on PODs 30, 32, 34, 37, 39–41, 43, and 44 remained positive. On POD 38 rifampin was discontinued and gentamicin was started. One week later doxycycline (2.5 mg/kg/dose every 12 hours) was added.


Successful treatment of a neonate with persistent vancomycin-resistant enterococcal bacteremia with a daptomycin-containing regimen.

Beneri CA, Nicolau DP, Seiden HS, Rubin LG - Infect Drug Resist (2008)

Patient course in relation to blood culture results and antimicrobial therapy.Abbreviations: Va,vancomycin; Li, linezolid; Amp/Sulb, ampicillin/sulbactam; Quin/Dalfo,quinprisitin/dalfopristin; Rif, rifampin; Da, daptomycin
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3108720&req=5

f1-idr-1-009: Patient course in relation to blood culture results and antimicrobial therapy.Abbreviations: Va,vancomycin; Li, linezolid; Amp/Sulb, ampicillin/sulbactam; Quin/Dalfo,quinprisitin/dalfopristin; Rif, rifampin; Da, daptomycin
Mentions: At 11 days of age a full-term girl with hypoplastic left heart syndrome underwent Stage I Palliation (Norwood with Sano modification) with a 5 mm Gortex shunt placement. On post-operative day (POD) 10, she developed fever; blood cultures (BACTEC Peds-plus) were taken through a central venous catheter and via venipuncture followed by removal and replacement of vascular catheters. Vancomycin was empirically started (Figure 1). Both blood cultures grew Enterococcus species. Creatinine was 1.6 mg/dL. On POD 13 the blood culture isolates were identified as vancomycin-resistant Enterococcus faecium (VRE, susceptibilities in Table 1) and antimicrobial therapy was changed to linezolid (10 mg/kg/dose every 8 hours). On POD 15 she became afebrile but blood cultures remained positive through POD 18. On POD 16, all vascular catheters were removed and replaced. The antimicrobial was changed to quinupristin/dalfopristin (7.5 mg/kg/dose every 8 hours) on POD 18. Ampicillin-sulbactam (50 mg/kg/dose every 12 hours) was added a day later for possible synergy. The patient remained critically ill. On POD 18 the patient underwent cardiac catheterization; a restricted Sano shunt was found and a stent was placed with improvement. On POD 20 she became febrile. Blood cultures obtained on PODs 20, 21, 22, and 23 were negative, but blood cultures obtained on PODs 26, 29, and 30 grew VRE. On POD 30 the antimicrobial was changed to daptomycin at a dose of 4 mg/kg/dose every 48 hours (serum creatinine, 0.9 mg/dL) and rifampin (18 mg/kg/day). Blood cultures obtained on PODs 30, 32, 34, 37, 39–41, 43, and 44 remained positive. On POD 38 rifampin was discontinued and gentamicin was started. One week later doxycycline (2.5 mg/kg/dose every 12 hours) was added.

Bottom Line: Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted.It was not cleared until daptomycin (in combination with doxycycline) was started.This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infectious Diseases, Schneider Children's Hospital - North Shore-LIJ Health System, New Hyde Park, New York, USA;

ABSTRACT
Infections caused by vancomycin-resistant enterococci (VRE) may be difficult to treat because of the limited armamentarium of antimicrobial agents. The difficulty is compounded in pediatric patients in general and neonates in particular because many of the newer antimicrobials have not been studied or approved for children. We report a 3-week-old infant who developed enterococcal bacteremia on post-operative day 10 after a surgical palliation for complex congenital heart disease that was complicated by acute renal failure. Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted. It was not cleared until daptomycin (in combination with doxycycline) was started. This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.

No MeSH data available.


Related in: MedlinePlus