Osteomyelitis with methicillin-resistant Staphylococcus aureus

Fitzpatrick, Donald J.; Cafferkey, Mary T.; Toner, M.; Beattie, Thomas; Keane, C. T.

doi:10.1016/0195-6701(86)90101-5

Cited by 14 publications

(6 citation statements)

References 12 publications

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“…In the small series of patients reported in the literature [13,14], vancomycin is used in repeated infusion of variable dosage and treatment duration. In Fitzpatrick's series [14], six out of 10 patients experienced no recurrence during a 2‐year follow‐up period. Nevertheless, repeated administration of the antibiotic, requiring hospitalization, is a limiting factor.…”

Section: Discussionsupporting

confidence: 79%

“…On the other hand, on a model involving MRSA, vancomycin resulted in sterilization of infected bone in 40% of the animals [12]. In the small series of patients reported in the literature [13,14], vancomycin is used in repeated infusion of variable dosage and treatment duration. In Fitzpatrick's series [14], six out of 10 patients experienced no recurrence during a 2‐year follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections

Bernard

Perbost

Carlès

et al. 1997

Clinical Microbiology and Infection

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OBJECTIVE: To evaluate the efficacy and safety of vancomycin constant-rate infusion over 24 h in the treatment of Gram-positive bone infections, METHODS: Vancomycin (40 mg/kg/day) was administered without a loading dose to 15 patients (12 male, three female) aged 23--90 years, weighing 46--85 kg, with postoperative chronic bone and joint infections. The 24-h dose was adjusted to maintain plasma levels between 25 and 35 mg/L. Mean duration of therapy was 6.2 months (4--8.5) via a portable infusion pump. Sites of infection included hip and femur (10), tibia (three), patella (one) and vertebrae (one). Sequestrectomy (two), removal of material (7/8 prosthetic hips, 1/5 metal implants) and debridement (two) were performed at the beginning of the treatment. Involved bacteria included Staphylococcus aureus (eight, six methicillin resistant), S. epidermidis (four methicillin-resistant), Enterococcus faecalis (one), Enterococcus avium (one) and Streptococcus bovis (one). RESULTS: MIC of vancomycin ranged from 1 to 4 mg/L. The mean vancomycin bone concentration when available was 67.7plus minus38.9 microg/L. Based on a mean post-treatment follow-up of 14plus minus4 months (6--20.6), cure was achieved in 10 patients (66.6%). Failures were related to the inability to remove the infected prosthesis (one) or implants (three) and to the persistence of a deep wound abcess (one). Adverse events included pruritus (four cases), tinnitus (two), mild transient elevation of creatinine level (three) and transient neutropenia (two). Vancomycin was maintained in all the patients. CONCLUSIONS: Prolonged treatment with vancomycin constant-rate infusion is effective and safe for treatment of Gram-positive chronic bone and joint infections, providing that complete surgical débridement and prosthetic material removal are performed.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections

Bernard

Perbost

Carlès

et al. 1997

Clinical Microbiology and Infection

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“…MRSA has been isolated from cases of osteomyelitis (8)(9)(10)(11)(16)(17)(18). With the increase in MRSA colonization and infection now being seen, the incidence of MRSA osteomyelitis can be expected to rise.…”

Section: Discussionmentioning

confidence: 99%

“…Methicillin-resistant Staphylococcus aureus (MRSA) causes a variety of infections, including osteomyelitis (8)(9)(10)(11)(16)(17)(18). Heretofore, vancomycin has been the only reliable antibiotic available for treating MRSA infections (16,17).…”

mentioning

confidence: 99%

Comparative evaluation of daptomycin (LY146032) and vancomycin in the treatment of experimental methicillin-resistant Staphylococcus aureus osteomyelitis in rabbits

Mader

Adams

1989

Antimicrob Agents Chemother

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A rabbit model for methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis was used to compare treatment with daptomycin, a new peptolide, and vancomycin. Daptomycin (4 mg/kg) and vancomycin (40 mg/kg) were injected subcutaneously every 12 and 6 h, respectively. After treatment, MRSA was found in bone cultures from 18 of 18 control rabbits, 10 of 17 animals treated with daptomycin, and 11 of 18 animals treated with vancomycin. Drug concentrations were measured in serum, uninfected bone, and infected bone 1 h after daptomycin or vancomycin was injected in a group of rabbits that had been infected for 3 to 4 weeks. Vancomycin was present at the highest concentrations in infected and uninfected bone. The results of this study suggest that daptomycin was similar to vancomycin in the eradication of MRSA from infected bone in an experimental model of osteomyelitis.

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“…Osteomyelitis was arrested in five of seven episodes, and follow-up evaluations ranged from 2 to 35 months. Fitzpatrick et al [183] describe ten patients with MRSA osteomyelitis on vancomycin therapy in association with radical debridement; eight patients showed clinical and radiological cure at follow-ups of 2-3.5. A foreign body had been left in situ in two of these patients.…”

Section: Antibiotic Treatment Of Osteomyelitis Without Implant Materialsmentioning

confidence: 98%

Italian Guidelines for the Diagnosis and Infectious Disease Management of Osteomyelitis and Prosthetic Joint Infections in Adults

et al. 2009

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Osteomyelitis with methicillin-resistant Staphylococcus aureus

Cited by 14 publications

References 12 publications

Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections

Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections

Comparative evaluation of daptomycin (LY146032) and vancomycin in the treatment of experimental methicillin-resistant Staphylococcus aureus osteomyelitis in rabbits

Italian Guidelines for the Diagnosis and Infectious Disease Management of Osteomyelitis and Prosthetic Joint Infections in Adults

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