Presenter: Dino, Sgarabotto, Padua, Italy
Authors: Dino Sgarabotto, Padua, Italy
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?
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