MRSA菌血症に対するテイコプラニン治療

Prognosis of patients with methicillin-resistant Staphylococcus aureus　bloodstream infection treated with teicoplanin: a retrospective cohort study　investigating effect of teicoplanin minimum inhibitory concentrations

BMC Infectious Diseases 2013, 13:182 doi:10.1186/1471-2334-13-182

テイコプラニンのMRSAに対するMICと予後の相関については過去に１つのsingle center retrospective studyで示されているのみであったため今回調査　

研究場所；Taipei Veterans General Hospital (TVGH, a major tertiary teaching hospital with 2,900　beds located in northern Taiwan) and National Taiwan University Hospital (NTUH, a major　tertiary teaching hospital with 2,500 beds located in northern Taiwan)

研究機関；Between 1 January 2006 and 31 December 2009

研究方法；a retrospective observational study

対象：18歳を超えるMRSA BSIs罹患者で他の感染をもたない者。3日間以上の6mg/kgのテイコプラミンで治療。過去にMRSA BSIを罹患したものは除く。

薬剤感受性；Susceptibility to teicoplanin was also determined using the Etest

結果；
MRSA BSI; 655 and 717adult patients with MRSA BSIs were admitted to TVGH and NTUH (テイコプラニン治療；Sixty-nine and 201 patients at NTUH and TVGH)

MIC of teicoplanin by Etest
≤1 mg/L 87 (41.4%)
1.5 mg/L 86 (41.0%)
2 mg/L 32 (15.2%)
> 2 mg/L 4 (1.9%)

副作用；Forty-two patients developed teicoplanin associated　adverse events 11.3 ± 3.2 days after usage of teicoplanin. These adverse events included　dizziness in 11 patients, headache in nine, skin rash in eight, fever in seven, leucopenia in　seven, and　thrombocytopenia in three.

結果；A high teicoplanin MIC, either by the Etest or micro-broth
dilution method, of the causative MRSA isolate was not a significant factor in the analyses　for all-cause Day 14 (p = 0.80 and 0.60, respectively), Day 30 mortality (p= >0.99 and 0.17,　respectively), or an un-favorable outcome at the end of teicoplanin therapy (p = 0.65 and　0.95, respectively).　For the 65 patients with abscess formation or osteomyelitis, drainage or debridement is not a　significant factors associated with Day 14 all-cause mortality and outcome evaluated when　discontinuing teicoplanin (p = 0.3526, and 0.3113). However, it is a protective factor independently against Day 30 all-cause mortality (OR, 0.29; p = 0.0250).
→MICと予後とは相関せず。　

生存率；Day 14 and Day 30 mortalities of adult patients with MRSA BSIs treated by teicoplanin were 13.0% and 26.3%,

→管理者コメント；かなりのNを集めているが、日本の様にテイコプラミン血中濃度測定を行っておらずあくまで参考のデータとなる。