sultamicillin and arbekacin

Vancomycin-resistant MRSA (VRSA with MIC > or = 8 mg/L) has been described, recently. Although the incidence of VRSA has been low in Japanese MRSA strains, hetero-VRSA (heterogeneously resistant VRSA with MIC levels of 2-4 mg/L) is found in considerable abundance in Japanese hospitals, that may explain fairly frequent therapeutic failure in the vancomycin treatment of MRSA infection. Hetero-VRSA may also serve as precursor for VRSA in some clinical settings where it is exposed to high concentrations (8 mg/L or above) of vancomycin.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Dibekacin; Drug Resistance, Multiple; Drug Therapy, Combination; Genotype; Humans; Japan; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Sulbactam; Vancomycin

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinupristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillin-sulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Dibekacin; Drug Resistance, Bacterial; Drug Synergism; Humans; In Vitro Techniques; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Sulbactam; Teicoplanin; Vancomycin; Virginiamycin

We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers related to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by 67Ga to be spondylo-diskitis at the level of L2-L3. The lesion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was treated with arbekacin (200 mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symptoms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400 mg/day).

Topics: Adult; Aged; Alanine; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Craniotomy; Dibekacin; Drug Therapy, Combination; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Methicillin Resistance; Postoperative Complications; Sepsis; Staphylococcal Infections; Sulbactam; Thienamycins; Treatment Outcome; Vancomycin