3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Cefazolin and Ertapenem Salvage Therapy Rapidly Clears Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

CIDからの報告。

持続性MSSA菌血症の11例に対するセファゾリンとエルタペネムの組み合わせの使用について

academic.oup.com

 

感想 

 

このコントロールされていない、無作為化されていない研究では、セファゾリンとエルタペネムの組み合わせの使用は、持続性MSSA菌血症の11例すべてで成功しました。

 

可能性を感じる一方、混沌とする恐れも感じる。。。

 

RCTを希望します。

 

 

Cefazolin and ertapenem combination therapy was used successfully to salvage 11 cases (6 endocarditis) of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, including immediate clearance (≤24 hours) in 8 cases. While in vitro synergy was modest, cefazolin plus ertapenem exhibited synergistic action in a rat model of MSSA endocarditis. The combination of cefazolin and ertapenem provides potent in vivo activity against MSSA beyond what is predicted in vitro and warrants further clinical study in the treatment of refractory MSSA bacteremia and endocarditis.

 

 

www.jwatch.org

Eleven patients with persistent MSSA bacteremia had rapid blood-stream clearance after changing to the combination drug treatment, and all survived.

No guidance is available regarding the management of patients with persistent bacteremia due to methicillin-susceptible Staphylococcus aureus (MSSA). Researchers previously described in vitro and in vivo synergism of cefazolin and ertapenem against MSSA. They now describe a case series using this treatment.

Eleven patients with persistent MSSA bacteremia lasting from 4 to 9 days despite antibiotic therapy were given a combination of cefazolin and ertapenem. Initial antibiotic regimens included vancomycin, piperacillin/tazobactam, ceftriaxone, and nafcillin, alone or in various combinations. Six patients had confirmed endocarditis. In the 8 of 9 (89%) instances with relevant measurements, blood cultures were negative within 24 hours after the change to combined cefazolin and ertapenem. All patients survived. In an animal model of MSSA endocarditis, the geometric mean bacterial concentration in vegetations was approximately 4-log lower with the combination than with cefazolin alone.

 

 

感染症プラチナマニュアル 2020 Grande

感染症プラチナマニュアル 2020 Grande

  • 作者:岡 秀昭
  • 出版社/メーカー: メディカルサイエンスインターナショナル
  • 発売日: 2020/02/04
  • メディア: 単行本