Clinical outcomes of teicoplanin use in the OPAT setting

Dabrowski, Hannah; Wickham, Helena; De, Surya K.; Underwood, Jonathan; Morris-Jones, Stephen; Logan, Sarah; Marks, Michael; Pollara, Gabriele

doi:10.1016/j.ijantimicag.2020.105888

Cited by 10 publications

(1 citation statement)

References 18 publications

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“…Teicoplanin, ceftriaxone, and ertapenem are common antibacterial agents used in this setting [ 28 , 29 ]. Teicoplanin was found to be an attractive antimicrobial that can be administered in the OPAT setting, in view of its favorable dosing regimen, low clinical failure rates, and acceptable safety profile [ 30 ]. Furthermore, rifampicin is a potent bactericidal drug that is effective against several gram-positive bacteria, and also displays good bone penetration [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Drug-Resistant Enterococcus faecalis with Teicoplanin plus Rifampicin: A Case Report

Papaetis,

Doukanaris,

Stylianou

et al. 2023

Am J Case Rep

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Patient: Male, 76-year-old Final Diagnosis: Extensively drug-resistant Enterococcus faecalis diabetic-foot myositis and osteomyelitis Symptoms: Fever, pain to his left lower foot and altered level of consciousness Clinical Procedure: Surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing in-total a twelve-week course of antibiotic therapy Specialty: Endocrinology and Metabolic • Infectious Diseases • General and Internal Medicine Objective: Rare disease Background: Foot ulcers are high-morbidity and debilitating complications of diabetes mellitus, and carry significantly increased rates of associated major amputations. They contribute to significantly worse quality of life. Osteomyelitis is a frequent complication of diabetic foot ulcers, since bacteria can contiguously spread from soft tissues to the bone, involving the cortex first and then the bone marrow. Unfortunately, clinically unsuspected osteomyelitis is frequent in persisting diabetic foot ulcers. It is associated with limb amputations and increased mortality. Case Report: We describe a 76-year-old man with long-standing insulin-treated type 2 diabetes, who experienced extensively drug-resistant Enterococcus faecalis diabetic foot myositis and osteomyelitis associated with sepsis. He was successfully treated with surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing, in total, a twelve-week course of antibiotic therapy. Conclusions: Clinically unsuspected osteomyelitis in patients with persisting diabetic foot ulcers has been associated with infections from highly resistant bacteria. Early and accurate diagnosis of diabetic foot osteomyelitis, as well as proper therapeutic approach (antimicrobial and surgical), is of great importance to reduce the risk of minor and major amputations, septic shock leading to multiple organ failure, and overall mortality.

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