4.3 ‑Resistant Gram Positives and Use of
Newer Antimicrobials in SOT
Dino Sgarabotto, Padua, Italy

As opening a case of MRSE infection of a vascular graft in HTx is presented : the association of Daptomycin and Doxycicline successfully eradicated the infection.

This is introducing the subject of Gram positive infections having now a steady several effective drugs available: not only old beta-lactamas and old glycopeptides but even a steady flow of new drugs: Synecid was the first one, followed by Linezolid, Tigecycline, Daptomycin, and more recently new lipoglycopeptides and forth generation cephalosporins.

This allows treating patients with different problems like: pulmonary and CSF infections, low platelets cases, allergic and intolerant patients.

However, MDR Enterococcus and prosthesis/device associated infections are the most difficult to deal with, once the device cannot be removed.

Antibiotic association is the way to go as it has always been since the synergistic effect of antibiotics was discovered decades ago.

Animal studies show that the effectiveness of different antibiotic associations is not the same on biofilms and newer drugs plus old Rifampin offer some solutions. Still, the field is open to further research. Daptomycin/Rifampin association is very promising, but Daptomycin/Tigacyclin (or Doxycicline) could be not les.

HIV and TB diseases looked impossible to treat till we used triple drug associations: are we going this way with device associated infections?

References

1. ‑Synercid plus vancomycin for the treatment of severe methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci infections: evaluation of 5 cases. Sgarabotto D, Cusinato R, Narne E, Scano F, Zignol M, Gambino A, Cattelan A, Meneghetti F, Cadrobbi P. Scand J Infect Dis. 2002;34(2):122-6

2. ‑Comparative Activities of Daptomycin, Linezolid, and Tigecycline against Catheter-Related Methicillin-Resistant Staphylococcus Bacteremic Isolates Embedded in Biofilm. Issam Raad, Hend Hanna, Ying Jiang, Tanya Dvorak, Ruth Reitzel, Gassan Chaiban, Robert Sherertz, and Ray Hachem Antimicrob Agents Chemother. 2007 May; 51(5): 1656–1660

3. ‑Future directions with daptomycin. David M. Livermore. J. Antimicrob. Chemother. (2008) 62 (suppl 3): iii41-iii49

4. ‑New lipoglycopeptides: a comparative review of dalbavancin, oritavancin and telavancin. Zhanel GG, Calic D, Schweizer F, Zelenitsky S, Adam H, Lagacé-Wiens PR, Rubinstein E, Gin AS, Hoban DJ, Karlowsky JA. Drugs. 2010 May 7;
70(7):859-86

5. ‑Ceftobiprole: a new option for treatment of skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus. Widmer AF Clin. Infect. Dis. March 2008; 46 (5): 656–8.