quinupristin-dalfopristin and Leukemia--Myeloid--Acute

To report the successful treatment of vancomycin-resistant Enterococcus (VRE) bacteremia using the combination of quinupristin/dalfopristin and high-dose ampicillin.. A 38-year-old African American woman with relapsed acute myeloid leukemia and neutropenic fever developed VRE bacteremia following 3 successive courses of vancomycin for methicillin-resistant staphylococcal infections. Treatment with linezolid was initiated; however, after 9 days of therapy, blood cultures continued to reveal VRE and the patient became febrile. The patient was subsequently switched to quinupristin/dalfopristin and high-dose ampicillin. The fever resolved and all subsequent blood cultures were negative after the initiation of combination therapy.. The emergence of VRE infections presents a treatment challenge in immunocompromised patients. When treating VRE infections in this patient population, the effectiveness of linezolid and quinupristin/dalfopristin is limited by their bacteriostatic activity when used as monotherapy. Recent in vitro data suggest synergistic activity with quinupristin/dalfopristin when used in combination with other antimicrobials in selected isolates of VRE.. Persistent VRE bacteremia was successfully treated in this neutropenic patient using the combination of high-dose ampicillin and quinupristin/dalfopristin. Case reports and in vitro data suggest that concomitant therapy with high-dose ampicillin may be an effective treatment alternative for VRE infections not responding to standard therapy.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Enterococcus faecium; Female; Humans; Leukemia, Myeloid, Acute; Neutropenia; Staphylococcal Infections; Vancomycin Resistance; Virginiamycin

Topics: Acetamides; Anti-Bacterial Agents; Bacteremia; Bone Marrow Transplantation; Drug Administration Schedule; Drug Therapy, Combination; Enterococcus faecium; Follow-Up Studies; Gram-Positive Bacterial Infections; Humans; Leukemia, Myeloid, Acute; Linezolid; Male; Middle Aged; Oxazoles; Oxazolidinones; Postoperative Complications; Treatment Failure; Treatment Outcome; Vancomycin Resistance; Virginiamycin