Pristinamycin as adjunctive therapy in the management of Gram-positive multi-drug resistant organism (MDRO) osteoarticular infection

• Published in: The Journal of infection 2008-09, Vol.57 (3), p.191-197
• Main Authors: Ruparelia, N, Atkins, B.L, Hemingway, J, Berendt, A.R, Byren, I
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Drug Resistance, Multiple, Bacterial; Female; General aspects; Gram-Positive Bacteria - drug effects; Gram-Positive Bacteria - isolation & purification; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Humans; Infectious Disease; Male; Medical sciences; Middle Aged; Osteoarthritis - drug therapy; Osteoarthritis - microbiology; Osteoarthritis - surgery; Osteoarticular infection; Osteomyelitis; Pharmacology. Drug treatments; Pristinamycin; Pristinamycin - adverse effects; Pristinamycin - therapeutic use; Prosthetic joint infection; Retrospective Studies; Treatment Outcome
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2008.07.002

Summary Objective Osteoarticular infection often requires prolonged antibiotic therapy as an adjunct to surgery. We report our experience using pristinamycin, an oral streptogramin, when conventional antibiotics were poorly tolerated or inappropriate because of multi-drug resistant organisms (MDROs). Methods We retrospectively identified, from pharmacy records, all patients prescribed pristinamycin between 1/1/2004 and 31/12/2006. We collected clinical and microbiological data. Results Twenty-one patients were identified (13 male and eight female patients, age range 18–83 years). Sixteen patients (76%) had infection due to MDROs and five (24%) were intolerant of conventional antibiotics. Ten patients received other concurrent oral antibiotics. Eleven of 21 (52%) patients remained free of recurrent infection off antibiotics at a mean follow up duration of 13 months, (range 4–25 months). Suppression of infection while still on therapy was achieved in a further four patients (19%) with a mean follow up of 11.5 months (range 5–15 months). Six patients (29%) failed therapy, all requiring a further surgical procedure. Conclusion Oral pristinamycin was a well tolerated and useful adjunctive treatment in this group with complex orthopaedic infection. Pristinamycin can be considered in patients with osteoarticular infection due to Gram-positive organisms when antibiotic multi-resistance or intolerance makes conventional therapies impossible. Summary We report our experiences of using pristinamycin in the management of 21 patients with Gram-positive MDRO osteoarticular infection or who were unable to tolerate more conventional regimens. Our results show that pristinamycin is well tolerated with outcomes comparable to those of other agents described in the literature on osteoarticular infection.