Pristinamycin in the treatment of MSSA bone and joint infection.

Abstract

OBJECTIVES:

The aim of this study was to evaluate pristinamycin in the treatment of MSSA bone and joint infection (BJI).

PATIENTS AND METHODS:

A retrospective, single-centre cohort study (2001-11) investigated outcome in adults receiving pristinamycin for MSSA BJI and pristinamycin-related adverse events (AEs).

RESULTS:

One hundred and two MSSA BJIs were assessed in 98 patients [chronic infection, 33.3%; and orthopaedic device-related infection (ODI), 67.6%]. Surgery was performed in 77.5% of total cases, and in all but three ODIs, associated with antibiotic therapy of a median total duration of 29.2 weeks. Pristinamycin was prescribed as a part of the initial intensive treatment phase (29.4%) and/or included in final maintenance therapy (83.3%) at a dose of 47.6 (45.5-52.6) mg/kg/day for 9.3 (1.4-20.4) weeks. AEs occurred in 13.3% of patients, consisting of gastrointestinal disorder (76.9%) or allergic reaction (23.1%), leading to treatment interruption in 11 cases. AEs were related to daily dose (OR, 2.733 for each 10 additional mg/kg/day; P = 0.049). After a follow-up of 76.4 (29.6-146.9) weeks, the failure rate was 34.3%, associated with ODI (OR, 4.421; P = 0.006), particularly when the implant was retained (OR, 4.217; P = 0.007). In most patients, the pristinamycin companion drug was a fluoroquinolone (68.7%) or rifampicin (21.7%), without difference regarding outcome.

CONCLUSIONS:

Pristinamycin is an effective, well-tolerated alternative therapeutic option in MSSA BJI, on condition that a daily dosage of 50 mg/kg is respected.

• Authors: Florent Valour, André Boibieux, Judith Karsenty, Marie-Paule Vallat, Evelyne Braun, Thomas Perpoint, François Biron, Frédéric Laurent, Sébastien Lustig, Christian Chidiac, Tristan Ferry, Lyon Bone and Joint Infection Study Group
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 71 Issue 4 Pg. 1063-70 (Apr 2016) ISSN: 1460-2091 [Electronic] England
• PMID: 26801082 (Publication Type: Journal Article)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Anti-Bacterial Agents
• Pristinamycin

Topics

• Aged
• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Arthritis, Infectious (drug therapy, microbiology, mortality)
• Bone Diseases, Infectious (drug therapy, microbiology, mortality)
• Cohort Studies
• Combined Modality Therapy
• Comorbidity
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Methicillin-Resistant Staphylococcus aureus (drug effects)
• Middle Aged
• Pristinamycin (pharmacology, therapeutic use)
• Staphylococcal Infections (drug therapy, microbiology, mortality)
• Treatment Outcome