L Ruffier d'Epenoux, P Barbier, E Fayoux, A Guillouzouic, R Lecomte, C Deschanvres, C Nich, P Bémer, M Grégoire, S Corvec
{"title":"假体关节感染后表皮葡萄球菌的体内选择:表型和基因组特征。","authors":"L Ruffier d'Epenoux, P Barbier, E Fayoux, A Guillouzouic, R Lecomte, C Deschanvres, C Nich, P Bémer, M Grégoire, S Corvec","doi":"10.1093/jacamr/dlae163","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Dalbavancin is a lipoglycopeptide antibiotic with a wide spectrum of activity against Gram-positive bacteria, including MDR isolates. Its pharmacokinetic properties and administration patterns could be useful for the treatment of bone and joint infections, especially prosthetic joint infections (PJIs).</p><p><strong>Introduction: </strong>We report the case of an 80-year-old man who experienced an acute periprosthetic joint infection of his right total knee arthroplasty (TKA). A DAIR procedure was done with tissue sampling, which allowed identification of a linezolid-resistant MDR <i>S. epidermidis</i> (LR-MDRSE) strain. The patient was then treated with dalbavancin (four injections).</p><p><strong>Methods: </strong>We studied the phenotypic and genomic evolution of the strains and plasma through concentrations of dalbavancin at different points in time.</p><p><strong>Results: </strong>After four injections (1500 mg IV) of dalbavancin over a 6 month period, the dalbavancin MIC increased 4-fold. Calculated <i>f</i>AUC<sub>0-24</sub>/MIC ratios were 945, 1239 and 766.5, respectively, at Days 49, 71 and 106, assuming an MIC of 0.032 mg/L. The PFGE dendrogram revealed 97% similarity among all the isolates. These results suggest acquisition by the <i>S. epidermidis</i> strain of dalbavancin resistance when the patient underwent dalbavancin treatment. A 4-amino-acid deletion in the <i>walK</i> gene coinciding with the emergence of phenotypic resistance was revealed by WGS without any other relevant indels.</p><p><strong>Conclusions: </strong>Despite dalbavancin treatment with pharmacokinetic management, emerging dalbavancin resistance in <i>S. epidermidis</i> was observed, resulting in treatment failure. This outcome led to a prosthesis revision and long-term suppressive antibiotic therapy, with no recurrence of PJI after an 18 month follow-up.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487905/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dalbavancin-resistant <i>Staphylococcus epidermidis in vivo</i> selection following a prosthetic joint infection: phenotypic and genomic characterization.\",\"authors\":\"L Ruffier d'Epenoux, P Barbier, E Fayoux, A Guillouzouic, R Lecomte, C Deschanvres, C Nich, P Bémer, M Grégoire, S Corvec\",\"doi\":\"10.1093/jacamr/dlae163\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Dalbavancin is a lipoglycopeptide antibiotic with a wide spectrum of activity against Gram-positive bacteria, including MDR isolates. Its pharmacokinetic properties and administration patterns could be useful for the treatment of bone and joint infections, especially prosthetic joint infections (PJIs).</p><p><strong>Introduction: </strong>We report the case of an 80-year-old man who experienced an acute periprosthetic joint infection of his right total knee arthroplasty (TKA). A DAIR procedure was done with tissue sampling, which allowed identification of a linezolid-resistant MDR <i>S. epidermidis</i> (LR-MDRSE) strain. The patient was then treated with dalbavancin (four injections).</p><p><strong>Methods: </strong>We studied the phenotypic and genomic evolution of the strains and plasma through concentrations of dalbavancin at different points in time.</p><p><strong>Results: </strong>After four injections (1500 mg IV) of dalbavancin over a 6 month period, the dalbavancin MIC increased 4-fold. Calculated <i>f</i>AUC<sub>0-24</sub>/MIC ratios were 945, 1239 and 766.5, respectively, at Days 49, 71 and 106, assuming an MIC of 0.032 mg/L. The PFGE dendrogram revealed 97% similarity among all the isolates. These results suggest acquisition by the <i>S. epidermidis</i> strain of dalbavancin resistance when the patient underwent dalbavancin treatment. A 4-amino-acid deletion in the <i>walK</i> gene coinciding with the emergence of phenotypic resistance was revealed by WGS without any other relevant indels.</p><p><strong>Conclusions: </strong>Despite dalbavancin treatment with pharmacokinetic management, emerging dalbavancin resistance in <i>S. epidermidis</i> was observed, resulting in treatment failure. This outcome led to a prosthesis revision and long-term suppressive antibiotic therapy, with no recurrence of PJI after an 18 month follow-up.</p>\",\"PeriodicalId\":14594,\"journal\":{\"name\":\"JAC-Antimicrobial Resistance\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487905/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAC-Antimicrobial Resistance\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jacamr/dlae163\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAC-Antimicrobial Resistance","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jacamr/dlae163","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Dalbavancin-resistant Staphylococcus epidermidis in vivo selection following a prosthetic joint infection: phenotypic and genomic characterization.
Background: Dalbavancin is a lipoglycopeptide antibiotic with a wide spectrum of activity against Gram-positive bacteria, including MDR isolates. Its pharmacokinetic properties and administration patterns could be useful for the treatment of bone and joint infections, especially prosthetic joint infections (PJIs).
Introduction: We report the case of an 80-year-old man who experienced an acute periprosthetic joint infection of his right total knee arthroplasty (TKA). A DAIR procedure was done with tissue sampling, which allowed identification of a linezolid-resistant MDR S. epidermidis (LR-MDRSE) strain. The patient was then treated with dalbavancin (four injections).
Methods: We studied the phenotypic and genomic evolution of the strains and plasma through concentrations of dalbavancin at different points in time.
Results: After four injections (1500 mg IV) of dalbavancin over a 6 month period, the dalbavancin MIC increased 4-fold. Calculated fAUC0-24/MIC ratios were 945, 1239 and 766.5, respectively, at Days 49, 71 and 106, assuming an MIC of 0.032 mg/L. The PFGE dendrogram revealed 97% similarity among all the isolates. These results suggest acquisition by the S. epidermidis strain of dalbavancin resistance when the patient underwent dalbavancin treatment. A 4-amino-acid deletion in the walK gene coinciding with the emergence of phenotypic resistance was revealed by WGS without any other relevant indels.
Conclusions: Despite dalbavancin treatment with pharmacokinetic management, emerging dalbavancin resistance in S. epidermidis was observed, resulting in treatment failure. This outcome led to a prosthesis revision and long-term suppressive antibiotic therapy, with no recurrence of PJI after an 18 month follow-up.