A retrospective analysis to estimate trough concentrations of teicoplanin in patients with suspected or documented Gram-positive infections

Abstract Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (Ctrough). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 Ctrough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The Ctrough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, Scr, CLcr, eGFR, BUN and Cys-C. ROC curve analysis revealed that CLcr and eGFR were more sensitive and specific for Ctrough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.

Monte Carlo simulation study to optimize administration regimens of linezolid, teicoplanin and daptomycin for Staphylococcal bloodstream infections / 中华传染病杂志

Objective:To predict and evaluate the antibacterial efficacy of linezolid, teicoplanin and daptomycin against Staphylococci bloodstream infections with Monte Carlo simulation, and to optimize the clinical administration program. Methods:A total of 1 847 Staphylococci strains isolated from blood samples between January 2018 to December 2019 were collected with the help of the Blood Bacterial Resistant Investigation Collaborative System (BRICS). Minimum inhibitory concentrations (MIC) of linezolid and daptomycin were detected by broth dilution method, while MIC of teicoplanin were detected by agar dilution method. The dosage regimens of linezolid were 800 mg once daily, 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours. The dosage regimens of teicoplanin were 400 mg once every 12 hours, 600 mg once every 12 hours, 800 mg once every 12 hours, and 1 000 mg once every 12 hours. The dosage regimens of daptomycin were 4 mg·kg -1·d -1, 6 mg·kg -1·d -1, 8 mg·kg -1·d -1, 10 mg·kg -1·d -1and 12 mg·kg -1·d -1. The probability of target attainment (PTA) and cumulative fraction of response (CFR) of three different dosage regimens were calculated by Monte Carlo simulation. A dosage regimen with CFR≥90.0% was a reasonable choice for empirical antimicrobial therapy. Results:PTA of linezolid against Staphylococci when MIC≤0.500 mg/L at four dosage regimens (800 mg once daily, 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours) were all over 90.0%. When MIC was 1.000 mg/L, the PTA of linezolid against Staphylococci under the dosages of 500 mg once every 12 hours, 600 mg once every 12 hours and 600 mg once every eight hours were 92.2%, 96.6% and 97.6%, respectively. The CFR of the four dosage regimens of linezolid were 73.9%, 83.7%, 90.8% and 95.3%, respectively. When MIC≤1.000 mg/L, PTA of teicoplanin against Staphylococci were all 100.0% at four dosage regimens (400 mg once every 12 hours, 600 mg once every 12 hours, 800 mg once every 12 hours and 1 000 mg once every 12 hours). When MIC was 2.000 mg/L, the PTA of teicoplanin (800 mg once every 12 hours and 1 000 mg once every 12 hours) against Staphylococci were both 100.0%. The CFR of the four dosage regimens of teicoplanin were 90.8%, 92.8%, 93.5% and 94.6%, respectively. When MIC≤0.500 mg/L, PTA of daptomycin against Staphylococci under the five dosages of 4 mg·kg -1·d -1, 6 mg·kg -1·d -1, 8 mg·kg -1·d -1, 10 mg·kg -1·d -1 and 12 mg·kg -1·d -1 were all over 90.0%. When MIC was 1.000 mg/L, the PTA of daptomycin against Staphylococci under the three dosages of 8 mg·kg -1·d -1, 10 mg·kg -1·d -1 and 12 mg·kg -1·d -1were 96.9%, 100.0% and 100.0%, respectively. The CFR of the five dosage regimens of daptomycin against Staphylococci were 97.4%, 99.2%, 99.9%, 100.0% and 100.0%, respectively. Conclusions:Linezolid (600 mg once every 12 hours), teicoplanin (400 mg once every 12 hours) and daptomycin (4 mg·kg -1·d -1) can achieve satisfactory antibacterial activity for Staphylococci bloodstream infections.

Study on the relationship between cystatin C level and the plasma trough concentration of teicoplanin / 药学实践杂志

Objective To investigate the relationship between cystatin C level and the plasma trough concentration of teicoplanin, so as to provide a reference for the rational application of teicoplanin in clinical practice. Methods The clinical data of the patients receiving teicoplanin, who admitted to our hospital from October 2017 to July 2020 were retrospectively analyzed. The distribution of teicoplanin concentration, the difference of teicoplanin concentration under different cystatin C level, and influence factors for teicoplanin concentration (<15 µg/ml) were analyzed. Results A total of 98 patients including 65 males and 33 females, aged 19 to 94 (52.2±16.2) years old, with 141 trough concentrations were enrolled. The trough concentration of teicoplanin was 11.51 (8.35, 19.07) µg/ml, and the range was 3.57-41.93 µg/ml. 95 cases (67.38%) had teicoplanin concentration <15 µg/ml. When the concentration of cystatin C was >1.05 mg/L, the trough concentration of teicoplanin were 11.37 (8.96, 20.52) µg/ml, significantly higher than those when the concentration of cystatin C was in normal [8.68 (6.34, 11.79) µg/ml, Z=−2.636, P<0.05]. Logistic regression analysis showed that cystatin C level was the influencing factor for teicoplanin trough concentration does not meet the standard (OR=1.529, 95%CI=1.001-2.336, P<0.05). Conclusion The concentration of teicoplanin is significantly increased when the cystatin C level is higher than the normal. Cystatin C level is the influence factor for teicoplanin trough concentration not meeting the standard. The cystatin C level may be considered as a reference for teicoplanin dosage adjustment in clinical practice.

Effects of Virus Inactivation Treatment of Plasma Specimen on Plasma Concentration Determination of Vorico- nazole，Linezolid，Vancomycin and Teicoplanin / 中国药房

OBJECTIVE：To study the effects of virus in activation treatment of plasma specimen on plasma concentration determination of voriconzole ，linezolid，vancomycin and teicoplanin. METHODS ：The remaining plasma of 36 inpatients in our hospital after routine blood concentration examination of voriconazole ，linezolid，vancomycin and teicoplanin were collected as specimen（9 drug-contained plasma specimens for each drug ），and merged into three different concentration levels （low，medium， high）of mixed samples according the results of routine blood test. Then the mixed samples with different concentration levels were divided into inactivated group and non-inactivated group ，with 3 samples in each group. The inactivated plasma samples were heated at 56 ℃ for 30 min in metal bath with constant temperature. Non-inactivated group were not treated. After pretreating plasma sample of 2 groups，2-dimensional liquid chromatography was used to detect plasma concentration of the four drugs ；the difference of detection result between inactivated group and non-inactivated group were analyzed. RESULTS ：Plasma samples containing voriconazole，linezolid，vancomycin and teicoplanin were still stable after heating at 56 ℃ for 30 min in metal bath with constant temperature. Compared with non-inactivated group ，relative error of plasma concentration detection result of above 4 drugs were all lower than 15％ in low ，medium，high concentration mixed samples of inactivated group. CONCLUSIONS ：Plasma samples can be inactivated by heating at 56 ℃ for 30 min in metal bath with constant temperature ，when the plasma concentration of voriconazole，linezolid，vancomycin and teicoplanin are determined by 2-dimensional liquid chromatography.

Population Pharmacokinetics of Teicoplanin in Chinese Adult Patients / 中国药学杂志

OBJECTIVE: To establish a population pharmacokinetics(PPK) model of teicoplanin(TEC) in Chinese adult patients and investigate the factors influencing TEC pharmacokinetic parameters. METHODS: A total of 222 blood samples and related information were prospectively collected from 139 inpatients with Gram-positive bacterial infection receiving TEC intravenously. A one-compartment model with first order elimination was used to perform the PPK analysis and the PPK model of TEC was developed via nonlinear mixed effects modeling(NONMEM) approach. The stability and prediction of the final model were evaluated by Bootstrap and normalized predictive distribution error (NPDE). Monte Carlo simulation was used to evaluate the effective of currently recommended dosing regimen. RESULTS: The creatinine clearance(CLcr) and albumin(ALB) were identified as the most significant covariate on the clearance rate of TEC. The established final model was: CL(L•h-1)=1.24×(CLcr/77)0.564×31/ALB;V(L)=69.2. It is verified that the established final model is stable, effective and predictable. For most patients with different serum albumin concentration and CLcr, the initial loading dose of 400 mg/q12h, iv, 3 times, and the maintenance dose of 400-800 mg•d-1 can achieve effective treatment of trough concentration. Severe infections need to adjust the loading dose to 800 mg/q12h, iv, 3 times, and maintain a dose of 400-800 mg•d-1 of the dosing regimens to ensure that the blood concentration reached 15 mg•L-1. CONCLUSION: This study reports that CLcr, ALB has a significant effect on TEC clearance and the model has important value for the individualization of TEC therapy in Chinese adult patients.

Determination the Total and Free Concentrations of Teicoplanin in Plasma by HPLC / 中国药学杂志

OBJECTIVE: To establish an HPLC method for the determination of total(Ct) and free(Cf) concentrations of teicoplanin (TEIC) in plasma. METHODS: For determing the free concentration, the plasma samples were prepared by ultrafiltration. A C18 column was used, with acetonitrile -0.01 mol•L-1 sodium dihydrogen phosphate (25∶75, pH adjusted to 3.3 by phosphoric acid) as the mobile phase, the detection wavelength was set at 240 nm, the column temperature was maintained at 35℃, and the flow rate was 1.0 mL•min-1. The specificity, linearity, the lower limit of quantitation, precession, recovery and stability of the developed method were validated. RESULTS: The free concentration was linear with in 0.5-50 μg•mL-1, the lower limit of quantification was 0.5 μg•mL-1, and the method recovery rate was 94.63%-103.72%. The intra-day and inter-day precision(RSD) were all less than 4.00; the linearity was good with in the total concentration of 1.562 5-100 μg•mL-1, the lower limit of quantification was 1.562 5 μg•mL-1, the method recovery rate was 94.55%-99.59%. The intra-day and inter-day precision(RSD) were all less than 4.00. The TEIC was all stability at the conditions of maintaining at room temperature for 10 h, after freeze-thaw cycle and keeping at 4℃ for 72 h. CONCLUSION: The method is simple, accurate, and sensitive, and is suitable for the clinical determination of total and free concentrations of teicoplanin and the study of pharmacokinetics.

Assay of unbound teicoplanin in human plasma by centrifugal ultrafiltration combined with ultra performance liquid chromatography-tandem mass spectrometry / 药学实践杂志

Objective To establish an assay method for unbound teicoplanin in plasma by centrifugal ultrafiltration combined with ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Methods Protein was removed from plasma by a Centrifree® ultrafiltration device. The ultrafiltrate was injected to determine the unbound concentration of teicoplanin. EndeadvorsilTM C18 column (1.8 μm, 50 mm×2.1 mm) was used with gradient elution of acetonitrile and 0.02 mol/L ammonium acetate solution (containing 0.1% formic acid). The detection was performed on a triple-quadrupole tandem mass spectrometer by multiple reaction monitoring (MRM)mode via electro spray ionization (ESI). Results The calibration curve of unbound teicoplanin in plasma was linear over the range of 0.10 to 8.00 μg/ml (r=0.999). The intra-assay precision and the inter-assay precision of samples didn't exceed 7.00%. The average relative recovery ratio was 97.9%, and the matrix effect factor was 0.97. The samples had good stability after being stored at room temperature for 10 h or at −20 ℃ for 15 days, and freeze-thawed 3 times (RSDs were all within 6.50%). Conclusion This method is convenient, fast, sensitive and accurate. It provided a basis for clinical development of teicoplanin unbound concentration monitoring.

Effects of Augmented Renal Clearance on Blood Trough Concentration of Patients Receiving High-dose Regimen of Teicoplanin / 中国药房

OBJECTIVE：To study the effects of augmented renal clearance （ARC）on blood trough concentration of patients receiving high-dose regimen of teicoplanin. METHODS ：Patients who received high-dose regimen of teicoplanin in the ICU were prospectively collected from the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital during Jul. 2018-Jun. 2020. They were divided into ARC group and normal renal function group according to corrected creatinine clearance. The dosage regimen of teicoplanin in the two groups were loading dose of 600 mg，q12 h×3 doses，maintenance dose of 6-10 mg/kg，qd，and the dosage was adjusted in combination with creatinine clearance rate and blood trough concentration. The trough concentration of blood samples which were collected 30 min before the 4th and 8th-10th dosage of teicoplanin were determined by HPLC. Trough concentration ，clinical efficacy ，Gram-positive bacterial clearance rate and the occurrence of ADR were compared between 2 groups. RESULTS ：A total of 56 patients were included and divided into ARC group （18 cases）and normal renal function group （38 cases）. ARC group had younger age （P＜0.001）and lower serum albumin level （P＝0.025）than normal renal function group. The trough concentrations before administration of the 4th and 8th-10th dosage in ARC group were lower than normal renal function group （P＝0.034；P＝0.035）. The trough concentrations in the ARC group and normal renal function group before 8th-10th dosage were all higher than 30 min before the 4th dosage （P＝0.003；P＜0.001）. The clinical efficacy rate and the clearance rate of Gram-positive bacteria in ARC group were 77.8％ and 76.2％，which were lower than those of the normal renal function group ，but there was no statistical difference （P＝0.195；P＝0.223）. There was no liver function damage ，hemocytopenia and allergic reaction in both groups ，but in the normal renal function group ，the causal relationship between acute renal damage and teicoplanin was assessed as “very likely ”in one patient. CONCLUSIONS ：ARC patients are younger ，most of them have hypoproteinemia，and the blood trough concentrations of teicoplanin in high-dose regimen are significantly lower than those of normal renal function patients. For critical ill ARC patients ，it is advisable to increase the loading dose of teicoplanin to make the trough concentration reach the target concentration range quickly.

Analysis of Antibacterial Activity of Graded Concentrations of Teicoplanin Mixed With Acrylic Bone Cement in Staphylococcal (Methicillin-resistant Staphylococcus aureus) Infections and to Compare itwith Vancomycin: An In Vitro Study

Background: Orthopedic infections by methicillin-resistant Staphylococcus aureus (MRSA) are becoming more frequent afterdevice implantation, and often resistant to many commonly used antibiotics. The new line of antibiotics such as vancomycin,meropenem, and teicoplanin is being used for the treatment of such infections intravenously. However, these antibiotics canalso be used along with bone cement as a local antibiotic spacer.Aims: The aim of the study was to compare in vitro antibacterial activity of vancomycin and teicoplanin and to know the optimumconcentration of teicoplanin at which there is maximum inhibition of bacteria.Materials and Methods: Three different brands of bone cement discs (Palacos-R + G, surgical Simplex P, and CMW1) withvancomycin and teicoplanin of different concentration used. Inoculating media with bacterial isolates of Staphylococcus aureus(Methicillin-resistant) of strain ATCC 2593 with known minimum inhibitory concentration were used. In each media two discs ofone formulation were placed and labeled accordingly. Readings were taken at 24 h, 48 h, and 6 days.Results: All the cement brands eluted vancomycin equally well, but the zone of inhibition for palacos was marginally highercompared to the other two. Teicoplanin when increased from 400 mg to 1200 mg concentration showed a dose-dependentinhibition of MRSA with an increase in the zone of inhibition in all cements, with palacos being highest.Conclusion: Teicoplanin in higher concentration is a better alternative to vancomycin in MRSA bone infection.

Progress on pharmacokinetics and dosage regime of teicoplanin in children / 中华临床感染病杂志

Teicoplanin is a glycopeptide antibiotic for treatment of gram-positive bacterial infections in children, especially for methicillin-resistant staphylococcus aureus infection.The body clearance of teicoplanin differs between child and adult.This article explores the suitable testing indicators based on the clinical medication guide and the latest research progress , as well as the pharmacokinetic and pharmacodynamics of teicoplanin , to provide information for individualized dosage regime of teicoplanin in children.

Rapid determination of teicoplanin concentration in human plasma by uplc and its application / 中国药学杂志

OBJECTIVE: To establish a rapid ultra-high performance liquid chromatography method for determining teicoplanin concentration in human plasma. METHODS: The samples were chromatographed on Waters Acquity UPLC BEH-C18 column using gradient elution method(mobile phase A:20 mmol•L-1 ammonium acetate;mobile phase B:acetonitrile). The absorption wavelength was set at 215 nm. The column temperature were maintained at 35 ℃. The teicoplanin concentration was calculated by internal standard method and external standard method, respectively. The results of the two methods were compared by paired t-test using SPSS statisticals software. RESULTS: The liner range of the calibration curve for teicoplanin was 3.15-100 μg•mL-1(r=0.999 9). The concentrations calculated by the two methods had good correlation without significant difference. CONCLUSION: This method is proved to be rapid, sensitive and suitable for the therapeutic drug monitoring and pharmacokinetic investigation of teicoplanin in human plasma.

Determination of Teicoplanin in Human Plasma and Related Factors Analysis / 中国药学杂志

OBJECTIVE: To investigate the related factors effecting the teicoplanin concentration..METHODS: The patients′ information who accepted teicoplanin therapy and their plasma on the fourth day treatment were collected. The plasma was processed and detected by HPLC method. A multiple linear regression method was used to explore the relationship between the teicoplanin concentration and other factors. RESULTS: The result of multiple linear regression shows that the teicoplanin concentration relates with the creatine clearance and hypersensitive C-reactive protein. CONCLUSION: The teicoplanin treatment regimen could be altered by the level of patients′ creatine clearance and hypersensitive C-reactive protein in order to deliver a better individual treatment.

Therapeutic drug monitoring of teicoplanin:an overview / 国际药学研究杂志

Teicoplanin is a new glycopeptide antibiotic marketed after vancomycin for the treatment of Staphylo- coccus aureus(SAU)infection. Previous studies have shown that teicoplanin is safer than vancomycin,especially in the nephrotoxicity,so the routine serum concentration monitoring was not performed in the clinical application of teico- planin. In recent years,it has been found that the individual differences frequently appeared in the clinical application of teicoplanin,and thus it has been suggested that the serum concentration monitoring should be carried out in its clinical application. However,the domestic studies on the serum teicoplanin concentration monitoring are rarely conducted,and its clinical application experience is insufficient in China. This paper reviews the therapeutic drug monitoring of teico- planin,in terms of the pharmacokinetic characteristics of teicoplanin,the correlation between the blood concentration with the efficacy and adverse reactions,and the factors influencing the blood concentration of teicoplanin,so as to pro- vide a reference for the therapeutic drug monitoring and the rational clinical application of teicoplanin.

Effect of sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus / 中国基层医药

Objective To investigate the effect of sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus.Methods From September 2014 to August 2017,0 cases of severe pneumonia patients in the Traditional Chinese Medicine Hospital of Zhoushan were gram positive coccus,tumbled to rina amine for patients treated with intravenous drip,the course of treatment was 7 days,and then intravenous drip their stead better treatment,treatment for 7 days,the clinical situation of patients before and after treatment respectively,the characteristics of signs and adverse reactions were analyzed.Results Among the 51 cases (63.75％),19 cases (23.75％),8 cases (10.00％),and 2 cases (2.5％),the total effective rate was 87.5 ％.In the distribution and clearance rate of pathogenic bacteria,the bacterial clearance rate of liniazolamide and the replacement of gram-positive coccus pneumoniae was 87.50％.There was no other adverse reaction.Conclusion Sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus has several good effects,high clearance rate of pathogenic bacteria,good security.

Teicoplanin trough concentrations following different loading doses in critically ill patients / 中国感染控制杂志

Objective To understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin,and find out optimal loading dose.Methods Severely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1,2016 to February 28,2017 were enrolled in the study.According to different drug loading doses (teicoplanin standard dose:6mg/kg;high dose:10mg/kg) and different creatinine clearance rates (Ccr:50mL/min as standard value),patients were divided into four subgroups:group of standard dose and normal Ccr (GsD1),group of standard dose and low Ccr (GSD2),group of high dose and normal Ccr (GHD1),group of high dose and low Ccr(GHD2).Serum Cmin,percentage of achieving target concentration,and adverse reactions of teicoplanin in different groups were compared.Results A total of 49 patients were enrolled in the study,17 patients were in GSD group,Cmin on 4th day before administration was (5.98 ± 2.67)mg/L;32 patients were in GHD group,Cmin on 4th day before administration was (9.05 ± 4.25)mg/L;Cmin in GHD group was higher than that in GsD group,and there was statistical difference between two groups(t=3.10,P=0.003).Values of Cmin in GSD1,GSD2,GHD1,and GHD2 groups were (5.78±2.72),(6.34±2.78),(8.21 ±3.77),and (12.07±4.81) mg/L respectively,differences among four groups were statistically significant(F =4.766,P =0.006).The Cmin in GHD2 group was higher than those in GHD1,GSD2,and GsD1 groups,percentage of achieving the target concentration were 9.09％ (1/11),16.67％ (1/6),28.00％(7/25),and 71.43％ (5/7) respectively,differences were statistically significant(x2=8.766,P=0.033).Complications associated with teicoplanin such as rash,damage to hepatic and renal function were not observed in all patients during the treatment course.Conclusion Whether the Ccr is normal or not,target Cmin can not be achieved early in patients given teicoplanin with standard loading dose;in patients with low Ccr,given high loading dose,target Cmin can be achieved early;while in patients with normal Ccr,higher loading dose may be needed.

Characteristics and Rational Use of Antimethicillin-resistant Staphylococcus Aureus (anti-MRSA) Drugs / 医药导报

This study is aimed to make a comprehensive introduction to the anti-MRSA drugs,and also to compare the safety and efficacy among a variety of anti-MRSA drugs.Finally,it is pointed that we should select the anti-MRSA drugs precisely according to different situation of disease when treating the infection with MRSA.Then we can make the individualized treatment for patients and provide a basis for the disease when treatment of patients as well.

Study Advances in the Analytical Methods for Teicoplanin / 中国药师

Teicoplanin is a kind of glycopeptide antibiotic extracted from actinomycetes after fermentation, which is mainly used for the treatment of multidrug-resistant gram-positive cocci infection. The domestic and overseas research literatures on the advances in the analytical methods for teicoplanin were consulted, reviewed and analyzed. The determination methods of teicoplanin mainly includ-ed in vivo and in vitro pharmaceutical analysis. The analytical methods involved high-performance liquid chromatography analysis, bio-assay determination, liquid chromatography-mass spectrometry analysis and micellar electrokinetic capillary chromatography, and a-mong them, HPLC technology was most commonly utilized in the determination of teicoplanin in biological samples and teicoplanin preparations. Much progress has been made in the analytical methods for teicoplanin, and further exploration of determination methods in vivo and in vitro will be beneficial to the quality control of the drug and guiding clinical rational administration.

Analysis of Drug Treatment Strategy for One Case of ARDS after Fracture Operation / 中国药师

Objective: To explore the entry points and monitoring points of individualized treatment for fracture surgery patients with ARDS.Methods: Clinical pharmacists comprehensively assessed the patient's conditions and looked up lots of literatures.Some suggestions on the anti-infection treatment efforts, glucocorticoid use dispute and rational use of ambroxol were offered.The efficacy and adverse reactions of drugs in the treatment process were monitored using some subjective and objective indicators.Results: The consensus about the pros and cons, dosages, as well as the possible dosage decrease of glucocorticoid therapy, the dosages of antimicrobial agents, and the dosages and treatment course of ambroxol was achieved between clinical pharmacists and doctors.As a result, the maximum benefits were obtained for the patient.Conclusion: Clinical pharmacists can explore the treatment and monitoring for specific diseases and find out intervention entry points of clinicians and patients to play a certain role in clinics, and accumulate treatment experience gradually.

Molecular analysis of methicillin-resistant Staphylococcus aureus dissemination among healthcare professionals and/or HIV patients from a tertiary hospital

Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.

Clinical Observation of Linezolid, Teicoplanin and Vancomycin in the Treatment of Hospital-acquired MRSA Pneumonia / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of linezolid,teicoplanin and vancomycin in the treatment of hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS:120 patients diagnosed as hospital-acquired MRSA pneumonia were divided into linezolid group,teicoplanin group and vancomycin group according to therapeutic regimen,with 40 cases in each group. Linezolid group received Linezolid injection 600 mg,ivgtt,bid;teicoplanin group received Teicoplanin injection 0.4 g,ivgtt,bid;vancomycin group received Vancomycin injection 1 000 mg,bid,ivgtt. 3 groups received 2 weeks of treatment. Clinical efficacy and bacterial clearance effective rate of 3 groups were observed as well as serum levels of inflammatory factors before and after treatment. ADR of 3 groups were compared. RESULTS:The clinical effective rates of linezolid group,teicoplanin group and vancomycin group were 90.0%,72.5% and 67.5%;the effective bacterial clearance rates were 85.0%,60.0% and 57.5%,respectively. The clinical effective rate and the effective bacterial clearance rate in linezolid group were significantly higher than those in teicoplanin group and vancomycin group,with statistical significance (P0.05). There was no statistical significance serum inflammatory factors among 3 groups before treatment (P>0.05). CRP and PCT of 3 groups de-creased significantly after treatment,and those of linezolid group were lower than teicoplanin group and vancomycin group,with statistical significance(P0.05). There was no statistical significance in the incidence of ADR among 3 groups (P>0.05). CONCLUSIONS:For hospital-acquired MRSA pneumonia,linezolid is better than teicoplanin and vancomycin in pneumonia control with good safety.