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Salvage therapy for complex bone and joint infections with ceftaroline: a multicentre, observational study
International Journal of Antimicrobial Agents 50 (2017) 277–280
Contents lists available at ScienceDirect
International Journal of Antimicrobial Agents j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / i j a n t i m i c a g
Letter to the Editor Salvage therapy for complex bone and joint infections with ceftaroline: a multicentre, observational study Sir, Bone and joint infections (BJIs) require complex treatment strategies, including surgical procedures and prolonged antimicrobial therapy, and are associated with significant morbidity and mortality. Multidrug-resistant micro-organisms, particularly staphylococci, represent a therapeutic challenge, with high rates of treatment failure [1]. Ceftaroline fosamil is a broad-spectrum cephalosporin antibiotic with activity against Enterobacteriaceae and Gram-positive organisms, including methicillin-resistant staphylococci [2]. Based on its in vitro activity, ceftaroline could be a potential therapeutic option for the treatment of prosthetic joint infection (PJI), either polymicrobial or caused by methicillin-susceptible or methicillinresistant (MR) Staphylococcus aureus and Staphylococcus epidermidis. The activity of ceftaroline has been established in experimental MR S. aureus acute osteomyelitis and PJI [3,4]. However, there are only a few clinical data assessing the role of ceftaroline in the management of BJI as well as regarding optimal dosing and the safety of prolonged exposure. Therefore, a retrospective study was performed to evaluate the efficacy and safety of ceftaroline for the treatment of BJI in three regional reference centres in France. All patients presenting between January 2013 and January 2015 with a microbiologically documented BJI and treated with ceftaroline for ≥48 h were selected. BJI was defined as the presence of local signs of infection with or without symptoms of general sepsis. Microbiological documentation required at least one positive culture from surgical specimens in the case of a typical micro-organism, such as S. aureus or Enterobacteriaceae, and at least two identical samples yielding the same pathogen in the case of a skin bacterium, such as coagulasenegative staphylococci (CoNS), Propionibacterium spp., Corynebacterium or Lactobacillus. Clinical outcome was assessed by the treating physician using standard criteria. Microbiological failure associated with clinical failure was defined as either a superinfection when a new pathogen was identified or as a recurrence when the initial micro-organism persisted. Baseline clinical and microbiological characteristics as well as treatment duration and outcome for the 19 patients included in the study are shown in Table 1. Most infections (16/19) involved orthopaedic devices (11 prosthesis and 5 osteosynthesis). Patients had experienced a mean of 3 surgical procedures [interquartile range (IQR) 5], most of them for BJI (11/15). Staphylococcus epidermidis was considered the causative agent of infection in 15 of 19 cases, with 11 (73.3%) of the 15 isolates being MR. The infection was polymicrobial in 16 cases (84.2%). Ceftaroline was administered for a median duration of 6 weeks (IQR 5.5 weeks) at a dose of 600 mg twice daily (b.i.d.) (n = 11) or 600 mg three times daily (t.i.d.) (n = 8).
Ceftaroline was given in combination with at least one other antibiotic in 17 cases (89.5%), mostly rifampicin (n = 7), trimethoprim/ sulfamethoxazole (SXT) (n = 3), fosfomycin (n = 2), linezolid (n = 2), vancomycin (n = 1), daptomycin (n = 1) or metronidazole (n = 2). Two cases of neutropenia were reported during treatment with ceftaroline, one in a 16-year-old male after 2 weeks of treatment at a dose of 600 mg t.i.d. and one in an 86-year-old woman after 8 weeks at a dose of 600 mg b.i.d. In both cases, ceftaroline was discontinued with rapid recovery of neutropenia. Two rashes were deemed related to ceftaroline and led to treatment interruption. The final outcome was cure in seven cases with a median follow-up of 6 months after the end of treatment, and failure in seven cases (six superinfections and one recurrence). To the best of our knowledge, this is the largest report on the clinical use of ceftaroline for the treatment of BJI. Owing to the retrospective design of the study and the complexity of management of many cases, it is difficult to draw definitive conclusions on the efficacy of this broad-spectrum cephalosporin and its specific role in this clinical situation. Nevertheless, it is noteworthy that only one recurrence was encountered, the other failures being superinfections due to other bacteria. CoNS, and among them S. epidermidis, cause an increasing number of BJIs, especially PJIs. These commensal skin bacteria behave like opportunistic pathogens and frequently carry genes leading to multidrug resistance, with up to 80% of strains being MR. Of note, in this series, susceptibility to levofloxacin and fusidic acid was observed in only 35% of cases. Hence, there is a need to evaluate the clinical efficacy and safety of antimicrobials with in vitro activity against isolates associated with BJI, and particularly resistant micro-organisms found in BJI. Haematological tolerance to ceftaroline is an issue that has been recently raised. In one study, the incidence of neutropenia was 14% and 21% in patients exposed for >2 weeks and >3 weeks, respectively [5]. Such an adverse event is well known with other β-lactams and, although there are no comparative figures, its incidence seems higher with ceftaroline. The exact mechanism of ceftaroline-induced myelosuppression is still unknown. In the current series, neutropenia occurred in a patient receiving a high dose of 600 mg t.i.d., but also in one patient with the standard 600 mg b.i.d. We cannot exclude that co-administration of SXT might have played a part in the first case. From a practical point of view, except duration of exposure, it seems impossible to identify other risk factors for myelotoxicity at the present stage of our knowledge, and it is probably wise to monitor complete blood counts weekly for the full course of treatment. In conclusion, ceftaroline is a treatment option for the management of BJI, either polymicrobial or due to multidrug-resistant CoNS, but close monitoring of haematological parameters is warranted in patients receiving >2 weeks of treatment. Funding: None. Competing interests: None declared. Ethical approval: This work has been approved by the Ethics Committee of Nantes University Hospital (Nantes, France) [reference RC16_0059].
http://dx.doi.org/10.1016/j.ijantimicag.2017.05.021 0924-8579/© 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
278
Table 1 Clinical and microbiological characteristics of 19 patients treated with ceftaroline (CPT) for bone and joint infection. Patient
Bacteria 2
2
3
4
5
6
7
8
9
10
70 F 21 50.6 Yes 3
16 M 23.7 137 Yes 7
61 M 28.7 132 Yes 2
23 M 15.8 143 Yes 3
83 F 25 73.8 Yes 5
38 F 19.9 107.9 No 0
88 F 37.1 60 Yes 0
84 M 19.5 28.7 Yes 0
44 F 20.3 140.7 No 3
86 F 22.7 86.2 Yes 9
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MSSE
Yes MRSE
Yes MSSE
Proteus mirabilis
MRSE
Enterococcus faecalis Enterobacter cloacae
Staphylococcus capitis Escherichia coli
Peptostreptococcus asaccharolyticus
Yes Pseudomonas aeruginosa Streptococcus mitis
Enterococcus faecium
Corynebacterium aurimucosum S. mitis
MRSE
Multiresistant staphylococci 600 mg × 2 Rifampicin
Multiresistant staphylococci 600 mg × 2 Daptomycin
Bacteria 3
MRSE
Bacteria 4 Bacteria 5 Bacteria 6 Antibiotic treatment Reason of CPT choice CPT daily dose Associated antibiotics
CPT duration (weeks) Reason for CPT discontinuation Outcome EOT 6 months 1 year
Streptococcus parasanguinis MSSE Candida albicans
P. mirabilis Propionibacterium avidum Bacteroides fragilis Multiresistant staphylococci 600 mg × 3 Rifampicin
Multiresistant staphylococci 600 mg × 3 SXT
Multiresistant staphylococci 600 mg × 3 Rifampicin, levofloxacin 12 EOT
Polymicrobial infection 600 mg × 3 Fosfomycin, SXT, metronidazole, fluconazole 2 Simplification
12 EOT
4 Neutropenia
Clinical cure NR NR
Clinical cure Clinical cure Failure
Clinical cure Failure Failure
Clinical cure Clinical cure Clinical cure
Multiresistant staphylococci 600 mg × 3 Rifampicin, clindamycin
Renal failure
Renal failure
600 mg × 2 Rifampicin
600 mg × 2 Linezolid
6 EOT
Polymicrobial infection 600 mg × 2 Colistin, metronidazole, fluconazole 17 EOT
6 Suppressive treatment
5 Suppressive treatment
4 Simplification
27 Neutropenia
Failure Failure Failure
Clinical cure Clinical cure Failure
Failure Failure Failure
Failure Failure Failure
Clinical cure Clinical cure NR
Failure Failure Failure
(continued on next page)
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
Patient characteristics Age (years) Sex BMI (kg/m2) CLCr (mL/min) Orthopaedic device No. of previous surgical procedures Microbiological data Polymicrobial infection Bacteria 1
1
Table 1 (continued)
Bacteria 2 Bacteria 3 Antibiotic treatment Reason of CPT choice CPT daily dose Associated antibiotics CPT duration (weeks) Reason for CPT discontinuation Outcome EOT 6 months 1 year
12
13
14
15
16
17
18
19
17 M
45 M 27.4 157 Yes 7
65 F 29.2 76 Yes 2
58 F 36.3 63 Yes 10
92 F 31.3 42 Yes 0
38 M 27.6 96 Yes 1
72 F 22.4 88 Yes 1
71 F 35.1 32 Yes 10
85 M 31.4 77 Yes 1
No MRSE
Yes MRSA
No MRSE
Yes MSSE
Yes S. capitis
Yes MRSA
No Staphylococcus haemolyticus
Yes MSSE
Staphylococcus condimenti
P. acnes
S. capitis
145.2 No 4
Yes Propionibacterium acnes MRSE
Staphylococcus lugdunensis
Bacillus cereus Corynebacterium
Multiresistant staphylococci 600 mg × 2 Rifampicin 17 EOT
Multiresistant staphylococci 600 mg × 3 Rifampicin 6 EOT
Intolerance to vancomycin 600 mg × 2 Fosfomycin 6 EOT
Clinical cure
Clinical cure
Clinical cure
NR NR
Clinical cure NR
Clinical cure NR
Renal failure 600 mg × 2 Linezolid 5 EOT
Failure (amputation) Failure Failure
Intolerance to vancomycin 600 mg × 2 – 2 Rash
Multiresistant staphylococci 600 mg × 3 SXT 1.3 Thrombocytopenia
Multiresistant staphylococci 600 mg × 2 Vancomycin 6 Anaemia
Multiresistant staphylococci 600 mg × 3 – 7 EOT
Intolerance to vancomycin 600 mg × 2 Piperacillin 4 Rash
Clinical cure
Clinical cure
Death
Clinical cure
Clinical cure
NR NR
Clinical cure Clinical cure
– –
NR NR
Failure (recurrence) Failure
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
Patient characteristics Age (years) Sex BMI (kg/m2) CLCr (mL/min) Orthopaedic device No. of previous surgical procedures Microbiological data Polymicrobial infection Bacteria 1
11
BMI, body mass index; CLCr, creatinine clearance; MRSE, methicillin-resistant Staphylococcus epidermidis; MSSE, methicillin-susceptible S. epidermidis; SXT, trimethoprim/sulfamethoxazole; EOT, end of treatment; NR, not reported; MRSA, methicillin-resistant Staphylococcus aureus.
279
280
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
References [1] Decousser JW, Desroches M, Bourgeois-Nicolaos N, Potier J, Jehl F, Lina G, et al. Susceptibility trends including emergence of linezolid resistance among coagulase-negative staphylococci and meticillin-resistant Staphylococcus aureus from invasive infections. Int J Antimicrob Agents 2015;46:622– 30. [2] Saravolatz LD, Stein GE, Johnson LB. Ceftaroline: a novel cephalosporin with activity against methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2011;52:1156–63. [3] Jacqueline C, Amador G, Caillon J, Le Mabecque V, Batard E, Miègeville AF, et al. Efficacy of the new cephalosporin ceftaroline in the treatment of experimental methicillin-resistant Staphylococcus aureus acute osteomyelitis. J Antimicrob Chemother 2010;65:1749–52. [4] Gatin L, Saleh-Mghir A, Tasse J, Ghout I, Laurent F, Crémieux AC. Ceftaroline– fosamil efficacy against methicillin-resistant Staphylococcus aureus in a rabbit prosthetic joint infection model. Antimicrob Agents Chemother 2014;58:6496– 500. [5] Furtek KJ, Kubiak DW, Barra M, Varughese CA, Ashbaugh CD, Koo S. High incidence of neutropenia in patients with prolonged ceftaroline exposure. J Antimicrob Chemother 2016;71:2010–13.
Damasie Malandain Infectious Diseases Department, Nantes University Hospital, Nantes, France Microbiology Department, Nantes University Hospital, Nantes, France Aurélien Dinh Infectious Diseases Unit, University Hospital Raymond Poincaré, Garches, France
Tristan Ferry Infectious Diseases Department, Hospices civils de Lyon, Lyon, France Sophie Touchais Orthopedic Surgery Department, Nantes University Hospital, Nantes, France Sébastien Lustig Orthopedic Surgery Department, Hospices civils de Lyon, Lyon, France Frédéric Laurent Microbiology Department, Hospices civils de Lyon, Lyon, France Stéphane Corvec Pascale Bémer Microbiology Department, Nantes University Hospital, Nantes, France Nathalie Asseray David Boutoille * Infectious Diseases Department, Nantes University Hospital, Nantes, France * Corresponding author. Infectious Diseases Department, Nantes University Hospital, Nantes, France. E-mail address: [email protected] (D. Boutoille) 7 March 2017 13 May 2017
Contents lists available at ScienceDirect
International Journal of Antimicrobial Agents j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / i j a n t i m i c a g
Letter to the Editor Salvage therapy for complex bone and joint infections with ceftaroline: a multicentre, observational study Sir, Bone and joint infections (BJIs) require complex treatment strategies, including surgical procedures and prolonged antimicrobial therapy, and are associated with significant morbidity and mortality. Multidrug-resistant micro-organisms, particularly staphylococci, represent a therapeutic challenge, with high rates of treatment failure [1]. Ceftaroline fosamil is a broad-spectrum cephalosporin antibiotic with activity against Enterobacteriaceae and Gram-positive organisms, including methicillin-resistant staphylococci [2]. Based on its in vitro activity, ceftaroline could be a potential therapeutic option for the treatment of prosthetic joint infection (PJI), either polymicrobial or caused by methicillin-susceptible or methicillinresistant (MR) Staphylococcus aureus and Staphylococcus epidermidis. The activity of ceftaroline has been established in experimental MR S. aureus acute osteomyelitis and PJI [3,4]. However, there are only a few clinical data assessing the role of ceftaroline in the management of BJI as well as regarding optimal dosing and the safety of prolonged exposure. Therefore, a retrospective study was performed to evaluate the efficacy and safety of ceftaroline for the treatment of BJI in three regional reference centres in France. All patients presenting between January 2013 and January 2015 with a microbiologically documented BJI and treated with ceftaroline for ≥48 h were selected. BJI was defined as the presence of local signs of infection with or without symptoms of general sepsis. Microbiological documentation required at least one positive culture from surgical specimens in the case of a typical micro-organism, such as S. aureus or Enterobacteriaceae, and at least two identical samples yielding the same pathogen in the case of a skin bacterium, such as coagulasenegative staphylococci (CoNS), Propionibacterium spp., Corynebacterium or Lactobacillus. Clinical outcome was assessed by the treating physician using standard criteria. Microbiological failure associated with clinical failure was defined as either a superinfection when a new pathogen was identified or as a recurrence when the initial micro-organism persisted. Baseline clinical and microbiological characteristics as well as treatment duration and outcome for the 19 patients included in the study are shown in Table 1. Most infections (16/19) involved orthopaedic devices (11 prosthesis and 5 osteosynthesis). Patients had experienced a mean of 3 surgical procedures [interquartile range (IQR) 5], most of them for BJI (11/15). Staphylococcus epidermidis was considered the causative agent of infection in 15 of 19 cases, with 11 (73.3%) of the 15 isolates being MR. The infection was polymicrobial in 16 cases (84.2%). Ceftaroline was administered for a median duration of 6 weeks (IQR 5.5 weeks) at a dose of 600 mg twice daily (b.i.d.) (n = 11) or 600 mg three times daily (t.i.d.) (n = 8).
Ceftaroline was given in combination with at least one other antibiotic in 17 cases (89.5%), mostly rifampicin (n = 7), trimethoprim/ sulfamethoxazole (SXT) (n = 3), fosfomycin (n = 2), linezolid (n = 2), vancomycin (n = 1), daptomycin (n = 1) or metronidazole (n = 2). Two cases of neutropenia were reported during treatment with ceftaroline, one in a 16-year-old male after 2 weeks of treatment at a dose of 600 mg t.i.d. and one in an 86-year-old woman after 8 weeks at a dose of 600 mg b.i.d. In both cases, ceftaroline was discontinued with rapid recovery of neutropenia. Two rashes were deemed related to ceftaroline and led to treatment interruption. The final outcome was cure in seven cases with a median follow-up of 6 months after the end of treatment, and failure in seven cases (six superinfections and one recurrence). To the best of our knowledge, this is the largest report on the clinical use of ceftaroline for the treatment of BJI. Owing to the retrospective design of the study and the complexity of management of many cases, it is difficult to draw definitive conclusions on the efficacy of this broad-spectrum cephalosporin and its specific role in this clinical situation. Nevertheless, it is noteworthy that only one recurrence was encountered, the other failures being superinfections due to other bacteria. CoNS, and among them S. epidermidis, cause an increasing number of BJIs, especially PJIs. These commensal skin bacteria behave like opportunistic pathogens and frequently carry genes leading to multidrug resistance, with up to 80% of strains being MR. Of note, in this series, susceptibility to levofloxacin and fusidic acid was observed in only 35% of cases. Hence, there is a need to evaluate the clinical efficacy and safety of antimicrobials with in vitro activity against isolates associated with BJI, and particularly resistant micro-organisms found in BJI. Haematological tolerance to ceftaroline is an issue that has been recently raised. In one study, the incidence of neutropenia was 14% and 21% in patients exposed for >2 weeks and >3 weeks, respectively [5]. Such an adverse event is well known with other β-lactams and, although there are no comparative figures, its incidence seems higher with ceftaroline. The exact mechanism of ceftaroline-induced myelosuppression is still unknown. In the current series, neutropenia occurred in a patient receiving a high dose of 600 mg t.i.d., but also in one patient with the standard 600 mg b.i.d. We cannot exclude that co-administration of SXT might have played a part in the first case. From a practical point of view, except duration of exposure, it seems impossible to identify other risk factors for myelotoxicity at the present stage of our knowledge, and it is probably wise to monitor complete blood counts weekly for the full course of treatment. In conclusion, ceftaroline is a treatment option for the management of BJI, either polymicrobial or due to multidrug-resistant CoNS, but close monitoring of haematological parameters is warranted in patients receiving >2 weeks of treatment. Funding: None. Competing interests: None declared. Ethical approval: This work has been approved by the Ethics Committee of Nantes University Hospital (Nantes, France) [reference RC16_0059].
http://dx.doi.org/10.1016/j.ijantimicag.2017.05.021 0924-8579/© 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
278
Table 1 Clinical and microbiological characteristics of 19 patients treated with ceftaroline (CPT) for bone and joint infection. Patient
Bacteria 2
2
3
4
5
6
7
8
9
10
70 F 21 50.6 Yes 3
16 M 23.7 137 Yes 7
61 M 28.7 132 Yes 2
23 M 15.8 143 Yes 3
83 F 25 73.8 Yes 5
38 F 19.9 107.9 No 0
88 F 37.1 60 Yes 0
84 M 19.5 28.7 Yes 0
44 F 20.3 140.7 No 3
86 F 22.7 86.2 Yes 9
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MRSE
Yes MSSE
Yes MRSE
Yes MSSE
Proteus mirabilis
MRSE
Enterococcus faecalis Enterobacter cloacae
Staphylococcus capitis Escherichia coli
Peptostreptococcus asaccharolyticus
Yes Pseudomonas aeruginosa Streptococcus mitis
Enterococcus faecium
Corynebacterium aurimucosum S. mitis
MRSE
Multiresistant staphylococci 600 mg × 2 Rifampicin
Multiresistant staphylococci 600 mg × 2 Daptomycin
Bacteria 3
MRSE
Bacteria 4 Bacteria 5 Bacteria 6 Antibiotic treatment Reason of CPT choice CPT daily dose Associated antibiotics
CPT duration (weeks) Reason for CPT discontinuation Outcome EOT 6 months 1 year
Streptococcus parasanguinis MSSE Candida albicans
P. mirabilis Propionibacterium avidum Bacteroides fragilis Multiresistant staphylococci 600 mg × 3 Rifampicin
Multiresistant staphylococci 600 mg × 3 SXT
Multiresistant staphylococci 600 mg × 3 Rifampicin, levofloxacin 12 EOT
Polymicrobial infection 600 mg × 3 Fosfomycin, SXT, metronidazole, fluconazole 2 Simplification
12 EOT
4 Neutropenia
Clinical cure NR NR
Clinical cure Clinical cure Failure
Clinical cure Failure Failure
Clinical cure Clinical cure Clinical cure
Multiresistant staphylococci 600 mg × 3 Rifampicin, clindamycin
Renal failure
Renal failure
600 mg × 2 Rifampicin
600 mg × 2 Linezolid
6 EOT
Polymicrobial infection 600 mg × 2 Colistin, metronidazole, fluconazole 17 EOT
6 Suppressive treatment
5 Suppressive treatment
4 Simplification
27 Neutropenia
Failure Failure Failure
Clinical cure Clinical cure Failure
Failure Failure Failure
Failure Failure Failure
Clinical cure Clinical cure NR
Failure Failure Failure
(continued on next page)
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
Patient characteristics Age (years) Sex BMI (kg/m2) CLCr (mL/min) Orthopaedic device No. of previous surgical procedures Microbiological data Polymicrobial infection Bacteria 1
1
Table 1 (continued)
Bacteria 2 Bacteria 3 Antibiotic treatment Reason of CPT choice CPT daily dose Associated antibiotics CPT duration (weeks) Reason for CPT discontinuation Outcome EOT 6 months 1 year
12
13
14
15
16
17
18
19
17 M
45 M 27.4 157 Yes 7
65 F 29.2 76 Yes 2
58 F 36.3 63 Yes 10
92 F 31.3 42 Yes 0
38 M 27.6 96 Yes 1
72 F 22.4 88 Yes 1
71 F 35.1 32 Yes 10
85 M 31.4 77 Yes 1
No MRSE
Yes MRSA
No MRSE
Yes MSSE
Yes S. capitis
Yes MRSA
No Staphylococcus haemolyticus
Yes MSSE
Staphylococcus condimenti
P. acnes
S. capitis
145.2 No 4
Yes Propionibacterium acnes MRSE
Staphylococcus lugdunensis
Bacillus cereus Corynebacterium
Multiresistant staphylococci 600 mg × 2 Rifampicin 17 EOT
Multiresistant staphylococci 600 mg × 3 Rifampicin 6 EOT
Intolerance to vancomycin 600 mg × 2 Fosfomycin 6 EOT
Clinical cure
Clinical cure
Clinical cure
NR NR
Clinical cure NR
Clinical cure NR
Renal failure 600 mg × 2 Linezolid 5 EOT
Failure (amputation) Failure Failure
Intolerance to vancomycin 600 mg × 2 – 2 Rash
Multiresistant staphylococci 600 mg × 3 SXT 1.3 Thrombocytopenia
Multiresistant staphylococci 600 mg × 2 Vancomycin 6 Anaemia
Multiresistant staphylococci 600 mg × 3 – 7 EOT
Intolerance to vancomycin 600 mg × 2 Piperacillin 4 Rash
Clinical cure
Clinical cure
Death
Clinical cure
Clinical cure
NR NR
Clinical cure Clinical cure
– –
NR NR
Failure (recurrence) Failure
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
Patient characteristics Age (years) Sex BMI (kg/m2) CLCr (mL/min) Orthopaedic device No. of previous surgical procedures Microbiological data Polymicrobial infection Bacteria 1
11
BMI, body mass index; CLCr, creatinine clearance; MRSE, methicillin-resistant Staphylococcus epidermidis; MSSE, methicillin-susceptible S. epidermidis; SXT, trimethoprim/sulfamethoxazole; EOT, end of treatment; NR, not reported; MRSA, methicillin-resistant Staphylococcus aureus.
279
280
Letter to the Editor / International Journal of Antimicrobial Agents 50 (2017) 277–280
References [1] Decousser JW, Desroches M, Bourgeois-Nicolaos N, Potier J, Jehl F, Lina G, et al. Susceptibility trends including emergence of linezolid resistance among coagulase-negative staphylococci and meticillin-resistant Staphylococcus aureus from invasive infections. Int J Antimicrob Agents 2015;46:622– 30. [2] Saravolatz LD, Stein GE, Johnson LB. Ceftaroline: a novel cephalosporin with activity against methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2011;52:1156–63. [3] Jacqueline C, Amador G, Caillon J, Le Mabecque V, Batard E, Miègeville AF, et al. Efficacy of the new cephalosporin ceftaroline in the treatment of experimental methicillin-resistant Staphylococcus aureus acute osteomyelitis. J Antimicrob Chemother 2010;65:1749–52. [4] Gatin L, Saleh-Mghir A, Tasse J, Ghout I, Laurent F, Crémieux AC. Ceftaroline– fosamil efficacy against methicillin-resistant Staphylococcus aureus in a rabbit prosthetic joint infection model. Antimicrob Agents Chemother 2014;58:6496– 500. [5] Furtek KJ, Kubiak DW, Barra M, Varughese CA, Ashbaugh CD, Koo S. High incidence of neutropenia in patients with prolonged ceftaroline exposure. J Antimicrob Chemother 2016;71:2010–13.
Damasie Malandain Infectious Diseases Department, Nantes University Hospital, Nantes, France Microbiology Department, Nantes University Hospital, Nantes, France Aurélien Dinh Infectious Diseases Unit, University Hospital Raymond Poincaré, Garches, France
Tristan Ferry Infectious Diseases Department, Hospices civils de Lyon, Lyon, France Sophie Touchais Orthopedic Surgery Department, Nantes University Hospital, Nantes, France Sébastien Lustig Orthopedic Surgery Department, Hospices civils de Lyon, Lyon, France Frédéric Laurent Microbiology Department, Hospices civils de Lyon, Lyon, France Stéphane Corvec Pascale Bémer Microbiology Department, Nantes University Hospital, Nantes, France Nathalie Asseray David Boutoille * Infectious Diseases Department, Nantes University Hospital, Nantes, France * Corresponding author. Infectious Diseases Department, Nantes University Hospital, Nantes, France. E-mail address: [email protected] (D. Boutoille) 7 March 2017 13 May 2017