Pristinamycin in the treatment of MSSA bone and joint infection

• Published in: Journal of antimicrobial chemotherapy 2016-04, Vol.71 (4), p.1063-1070
• Main Authors: Valour, Florent, Boibieux, André, Karsenty, Judith, Vallat, Marie-Paule, Braun, Evelyne, Perpoint, Thomas, Biron, François, Laurent, Frédéric, Lustig, Sébastien, Chidiac, Christian, Ferry, Tristan
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis, Infectious - drug therapy; Arthritis, Infectious - microbiology; Arthritis, Infectious - mortality; Bioengineering; Bone Diseases, Infectious - drug therapy; Bone Diseases, Infectious - microbiology; Bone Diseases, Infectious - mortality; Cohort Studies; Combined Modality Therapy; Comorbidity; Drug dosages; Drug therapy; Female; Humans; Kaplan-Meier Estimate; Life Sciences; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Middle Aged; Pharmacology; Pristinamycin - pharmacology; Pristinamycin - therapeutic use; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Transplants & implants; Treatment Outcome
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkv457

The aim of this study was to evaluate pristinamycin in the treatment of MSSA bone and joint infection (BJI). A retrospective, single-centre cohort study (2001-11) investigated outcome in adults receiving pristinamycin for MSSA BJI and pristinamycin-related adverse events (AEs). 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. Pristinamycin is an effective, well-tolerated alternative therapeutic option in MSSA BJI, on condition that a daily dosage of 50 mg/kg is respected.