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Dalbavancin treatment of prosthetic knee infection due to oxacillin-resistant Staphylococcus epidermidis
Tratamiento con dalbavancina de infección protésica de rodilla por Staphylococcus epidermidis resistente a la oxacilina
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"paginaInicial" => "142" "paginaFinal" => "143" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Ramírez Hidalgo, Alfredo Jover-Sáenz, Mercè García-González, Fernando Barcenilla-Gaite" "autores" => array:4 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Ramírez Hidalgo" "email" => array:1 [ 0 => "ferchita@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Jover-Sáenz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Mercè" "apellidos" => "García-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" 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id="par0005" class="elsevierStylePara elsevierViewall">Infections associated with prosthetic joints are a serious health problem which require multi-disciplinary surgical and medical management. The situation may be complex in the case of allergy, resistance or contraindications to commonly used antibiotics if there are no alternatives. Dalbavancin may be an option but up until now no cases of prosthetic infection treated with this antibiotic have been published, according to the PubMed (years 2000–2017) database with key search words of: dalbavancin and prosthesis. A late reported case of prosthetic infection caused by <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and treated with dalbavancin is described.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a woman aged 55 with a history of chronic kidney disease, short bowel syndrome, the carrier of a central venous catheter for total parenteral long-term nutrition and who had a knee arthroplasty in 2009. After 7 years she presented with signs of prosthetic knee infection. Complete removal of the prosthetic knee and the implantation of a spacer impregnated with vancomycin and gentamicin was carried out. In the samples obtained during the procedure <span class="elsevierStyleItalic">S. epidermidis</span> was isolated, with the minimum inhibitory concentration (MIC) for each antibiotic as described below: vancomycin sensitive (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1), daptomycin (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.5) and linezolid (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1); resistant to cotrimoxazol (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2/38), clindamycin (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2), oxacillin (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4) and levofloxacin (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>4). Due to the chronic kidney disease, we believed it correct not to use vancomycin, and a treatment with daptomycin in monotherapy was selected for 10 days. When the moment for sequential therapy was reached, the oral alternative with elevated bioavailability was linezolid, which was not used as its complete absorption could not be ensured due to the short bowel syndrome. In order to protect the catheter required for parenteral nutrition and avoid a prolonged hospital stay, outpatient treatment with dalbavancin was administered when its sensitivity by ETEST<span class="elsevierStyleSup">®</span> (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.047) was made known and in accordance with the recommendations from the Spanish Medicine Agency.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> A first dose of 1000<span class="elsevierStyleHsp" style=""></span>mg iv was administered followed by a weekly dose of 500<span class="elsevierStyleHsp" style=""></span>mg iv for 3 weeks. Two months after becoming asymptomatic and with no signs of infection or organ failure, reimplantation was carried out with continuation of empirical antibiotic treatment until negative obtainment of a total of 5 intraoperative cultures was made from the bone-prosthesis interphase, spacer and synovial fluid. Nine months after follow-up the patient continues in complete remission.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Infection associated with prostheses is one of the most serious complications of arthroplasty. The estimated rate of infection for knee arthoplasties in our environment is between 2% and 3%, with the staphylococcus bacteria being responsible for around 65% of cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> Combined therapy based on the extraction of prosthetic material, together with antimicrobial treatment obtains healing rates of around 80%.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Dalbavancin is a parenteral antibiotic of the lipoglycopeptide group, with good action and penetrability in tissue compartments and demonstrates good bacterial activity compared with the majority of gram positive organisms.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> The susceptibility of dalbavancin compared with negative coagulase staphylococcus is around 100%.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Dalbavancin has been assessed <span class="elsevierStyleItalic">in vitro</span>, with acceptable results in biofilms generated by staphylococcal infections, although there not enough evidence with regard to prosthetic joint material.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our case, with regard to dosing, the recognised recommendations used for treatment of acute skin and soft tissue infection in adult patients were used. This is the only indication which has been approved up until now.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Unlike other antimicrobials where association with rifampicin has proven to be effective, its use in combined therapy does not appear to have been confirmed by the available scientific data which has supported it up until now, and for this reason monotherapy was chosen as therapy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, and as a result of this experience, dalbavancin could be used as an alternative in the treatment of oseoarticular infections caused by gram positive bacteria in the event of no other efficacious antimicrobial alternatives existing.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramírez Hidalgo M, Jover-Sáenz A, García-González M, Barcenilla-Gaite F. Tratamiento con dalbavancina de infección protésica de rodilla por <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> resistente a la oxacilina. Enferm Infecc Microbiol Clin. 2018;36:142–143.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0010" href="https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IIPT-dalbavancina-Xydalba.pdf">https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IIPT-dalbavancina-Xydalba.pdf</span> [accessed 19.04.17]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Informe de Posicionamiento Terapéutico de dalbavancina (Xydalba<span class="elsevierStyleSup">®</span>). 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 12 | 2 | 14 |
| 2024 September | 9 | 3 | 12 |
| 2024 August | 19 | 3 | 22 |
| 2024 July | 14 | 2 | 16 |
| 2024 June | 20 | 8 | 28 |
| 2024 May | 11 | 4 | 15 |
| 2024 April | 14 | 9 | 23 |
| 2024 March | 14 | 3 | 17 |
| 2024 February | 10 | 1 | 11 |
| 2024 January | 12 | 1 | 13 |
| 2023 December | 13 | 3 | 16 |
| 2023 November | 13 | 4 | 17 |
| 2023 October | 16 | 4 | 20 |
| 2023 September | 7 | 0 | 7 |
| 2023 August | 8 | 2 | 10 |
| 2023 July | 8 | 2 | 10 |
| 2023 June | 20 | 0 | 20 |
| 2023 May | 20 | 4 | 24 |
| 2023 April | 28 | 2 | 30 |
| 2023 March | 17 | 1 | 18 |
| 2023 February | 20 | 6 | 26 |
| 2023 January | 27 | 5 | 32 |
| 2022 December | 15 | 4 | 19 |
| 2022 November | 9 | 7 | 16 |
| 2022 October | 13 | 11 | 24 |
| 2022 September | 13 | 6 | 19 |
| 2022 August | 17 | 8 | 25 |
| 2022 July | 11 | 6 | 17 |
| 2022 June | 15 | 10 | 25 |
| 2022 May | 18 | 7 | 25 |
| 2022 April | 26 | 6 | 32 |
| 2022 March | 13 | 5 | 18 |
| 2022 February | 18 | 5 | 23 |
| 2022 January | 44 | 3 | 47 |
| 2021 December | 31 | 10 | 41 |
| 2021 November | 38 | 14 | 52 |
| 2021 October | 18 | 6 | 24 |
| 2021 September | 11 | 9 | 20 |
| 2021 August | 25 | 12 | 37 |
| 2021 July | 16 | 10 | 26 |
| 2021 June | 17 | 8 | 25 |
| 2021 May | 32 | 13 | 45 |
| 2021 April | 48 | 20 | 68 |
| 2021 March | 41 | 13 | 54 |
| 2021 February | 31 | 9 | 40 |
| 2021 January | 27 | 10 | 37 |
| 2020 December | 14 | 8 | 22 |
| 2020 November | 19 | 4 | 23 |
| 2020 October | 10 | 4 | 14 |
| 2020 September | 15 | 12 | 27 |
| 2020 August | 21 | 5 | 26 |
| 2020 July | 20 | 5 | 25 |
| 2020 June | 16 | 16 | 32 |
| 2020 May | 20 | 13 | 33 |
| 2020 April | 13 | 7 | 20 |
| 2020 March | 29 | 6 | 35 |
| 2020 February | 20 | 11 | 31 |
| 2020 January | 12 | 6 | 18 |
| 2019 December | 18 | 7 | 25 |
| 2019 November | 19 | 2 | 21 |
| 2019 October | 19 | 6 | 25 |
| 2019 September | 27 | 9 | 36 |
| 2019 August | 27 | 11 | 38 |
| 2019 July | 21 | 9 | 30 |
| 2019 June | 69 | 26 | 95 |
| 2019 May | 152 | 36 | 188 |
| 2019 April | 40 | 11 | 51 |
| 2019 March | 6 | 4 | 10 |
| 2019 February | 14 | 15 | 29 |
| 2019 January | 8 | 0 | 8 |
| 2018 December | 6 | 2 | 8 |
| 2018 November | 4 | 0 | 4 |
| 2018 October | 8 | 8 | 16 |
| 2018 September | 7 | 2 | 9 |
| 2018 August | 2 | 0 | 2 |
| 2018 February | 8 | 0 | 8 |
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