Retrospective case-control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy.

Glycopeptides have been considered the antimicrobials of choice for serious meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) infections for several years. Daptomycin is a new option for the treatment of these infections, including those exhibiting reduced susceptibility to glycopeptides. The aim of this study was to compare glycopeptides and daptomycin for the treatment of infections caused by MRSA or MR-CoNS. Data for 106 patients with bloodstream infections (bacteraemia or infective endocarditis) or skin and soft-tissue infections (SSTIs) were retrospectively reviewed, of which 43 were treated with daptomycin (DAP group) and 63 were treated with vancomycin or teicoplanin (GLYCO group). Patients included in the two comparison groups were homogeneous in terms of age, risk factors and clinical severity. Aetiology was mainly represented by MRSA in both groups, followed by various species of MR-CoNS. Daptomycin was used more frequently in patients with central venous catheter-associated bacteraemia or pacemaker-associated infection. Patients with SSTIs included in the GLYCO group had a longer mean duration of antibiotic therapy (18.2 days vs. 14.6 days; P=0.009) and a longer mean length of hospital stay (28.2 days vs. 19.6 days; P=0.01) compared with those included in the DAP group. A longer mean duration of antibiotic therapy was also observed in patients with bloodstream infections receiving glycopeptide therapy (25.6 days vs. 18 days; P=0.004). In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting.

[Linezolid therapy for the treatment of nocardial infection: report of a case and review of the literature]. / Effcacia di linezolid nel trattamento della nocardiosi: descrizione di un caso e rassegna della letteratura.

Treatment of Nocardia infections continues to be difficult, especially for central nervous system infections or disseminated diseases and when sustained by highly drug-resistant species such as Nocardia farcinica. Linezolid, the first oxazolidinone approved for clinical use, shows an excellent in vitro activity against all species of Nocardia, and achieves good central nervous system and lung concentrations. We describe the case of a patient with pulmonary nocardiosis and intolerance to trimethoprim/sulfamethoxazole successfully treated with linezolid, and review all the published cases of systemic nocardiosis treated with this agent. On the basis of the available evidence, linezolid appears an effective option for the treatment of nocardiosis.

Successful treatment of Corynebacterium urealyticum encrusted cystitis: a case report and literature review.

Encrusted cystitis is a very rare chronic inflammatory disease of the bladder characterized by precipitation and incrustation of phosphate and ammonium-magnesium salts on the vescical mucosa, caused by urinary infection due to urolithic microorganisms. Corynebacterium urealyticum or Corynebacterium group D2, a multiple antibiotic-resistant urea-splitting bacterium, is the most frequently incriminated aetiology. We report a case of a 57-year-old man affected by systemic erythematosus lupus with a long history of dysuria and suprapubic pain who underwent percutaneous nephrostomy drainage with urethral stenting for lupoid obstructive uropathy. Before the diagnosis of encrusted cystitis by Corynebacterium urealyticum was established, the patient underwent five cystoscopies to remove the plaques and multiple unsuccessful antibiotic treatment courses. Eventually the infection was definitively cured after a two-week course with intramuscular teicoplanin.

In vitro activity of fosfomycin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy.

Fosfomycin is a molecule that inhibits the early stage of peptidoglycan synthesis and shows a broad-spectrum bactericidal activity against Gram-positive and Gram-negative bacteria. Using the Killing-curve method, we tested the in vitro bactericidal activity of fosfomycin alone or in combination with vancomycin or teicoplanin at a concentration of 8 microg/mL, that is easily achievable in serum at standard dosing regimens, against seven methicillin-resistant Staphylococcus aureus strains, isolated from patients with well documented device-associated infections unresponsive to or relapsing after glycopeptide therapy. MICs of vancomycin ranged from 1 to 4 microg/mL, MICs of teicoplanin from 2 to 8 microg/mL; MICs of fosfomycin were 8 microg/mL for two strains and >128 microg/mL for the remaining strains. The seven strains proved tolerant when tested for vancomycin and teicoplanin used alone at 2x MIC concentration. Fosfomycin was bactericidal (reduction of 2 log of the inoculum) only against the two susceptible strains. In all cases both vancomycin and teicoplanin in combination with fosfomycin developed bactericidal synergism already at a concentration of 1x MIC. If these results are confirmed by in vivo experiments, the combination of fosfomycin with glycopeptides might be useful for treating device-associated infections, and in preventing the phenomenon of increasing MICs for glycopeptides.

[Non-tubercular and non-brucellar spondylodiscitis: preliminary clinico-microbiologic analysis of 37 cases]. / Spondilodisciti non tubercolari e non brucellari: analisi clinico-microbiologica preliminare di 37 casi.

Disk-space infection caused by organisms other than Mycobacterium tuberculosis or Brucella species seems to be an emerging disease due to an increase of the population at risk. However, few data are presently available from Italian institutions. In this article we report our "tot" month prospective experience on etiology and clinical presentation of disk-space infections in relation to their community (COM) or nosocomial (postoperative [POS] or non-postoperative [NPOS]) acquisition. Major results were: 1) a different microbial distribution among etiologies of COM, NPOS and POS infections; 2) more frequent distance infection as predisponing factor among NPOS infection than among COM and NPOS ones; 3) absence of fever and more frequent radicular extension of pain among POS infections. Due to the numerous potential microbial etiologies, culture of TC guided-disk aspirated material is of paramount importance for pathogen-targeted antimicrobial therapy.