virginiamycin and Endocarditis

Though the increased resistance to antibiotics observed worldwide is not a major concern in France, treatment of methicillin-resistant S. aureus has important limitations. New antibiotics have recently been marketed or will soon be (quinupristin-dalfopristin, linelozide, tigecyclin, daptomycin, ceftobiprole, dalbavancin). Their role, which has been documented in several forms of acute infections, remains to be established in infective endocarditis. At present, only treatment of methicillin-resistant S. aureus right-sided endocarditis justifies the use of daptomycin, preferably in association with rifampicin, when the use of vancomycin is not possible or contraindicated.

Topics: Acetamides; Anti-Bacterial Agents; Daptomycin; Drug Resistance, Bacterial; Endocarditis; Gram-Positive Bacterial Infections; Humans; Linezolid; Minocycline; Oxazolidinones; Tigecycline; Virginiamycin

Synercid (quinupristin/dalfopristin), the first semi-synthetic injectable streptogramin, is a promising alternative to glycopeptides against many Gram-positive multiresistant bacteria. Vancomycin is still considered an effective agent for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections but therapeutic failures with glycopeptides have been observed, even for the treatment of infections caused by S. aureus strains sensitive to vancomycin. Synercid, in combination with a glycopeptide, may address this problem without causing significant side effects due to the different toxicity patterns of the 2 antimicrobials. This study reports our experience with the combination of Synercid and vancomycin in 5 patients with severe infection caused by MRSA or methicillin-resistant coagulase-negative Staphylococcus.

Topics: Abdominal Abscess; Adult; Aged; Anti-Bacterial Agents; Coagulase; Drug Therapy, Combination; Endocarditis; Female; Heart-Assist Devices; Humans; Male; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Virginiamycin

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Coronary Artery Bypass; Diabetes Mellitus, Type 1; Drug Hypersensitivity; Endocarditis; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Penicillins; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Superinfection; Vancomycin; Virginiamycin; Wound Infection