Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with Staphylococcus aureus
Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with Staphylococcus aureus
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DOI：
10.1016/j.ijantimicag.2017.04.011
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发表时间：
2018-01-01
影响因子：
10.8
通讯作者：
Soriano, Alex
中科院分区：
文献类型：
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作者：
Wouthuyzen-Bakker, Marjan;Tornero, Eduard;Soriano, Alex
目的：氟喹诺酮与利福平的组合是治疗由葡萄球菌引起的人工关节感染（PJI）的基础之一。莫西沙星对甲氧西林敏感的金黄色葡萄球菌（MSSA）具有高度活性，因此是一种有吸引力的药物。然而，几项研究报告，当与利福平联合使用时，血清中的利福沙星水平降低。临床相关性仍不清楚。我们确定的结果与早期急性PJI引起的MSSA治疗无论是利福沙星/利福平或左氧氟沙星/rifampin.Methods：与利福沙星/利福平（格罗宁根大学医学中心）或左氧氟沙星/利福平（巴塞罗那医院诊所）治疗的患者的医疗文件进行了回顾性审查（2005-2015）。治疗失败定义为需要翻修手术和/或抑制性治疗、感染死亡或随访期间感染复发。观察到两个队列之间基线特征的差异，但失败的预后参数，如KLIC评分所定义的，（肾衰竭、肝硬化、首次手术、C反应蛋白和骨水泥型假体），两组间相似（阿氟沙星组2.9 [1.5 SD] vs.左氧氟沙星组2.2 [1.2 SD][P = 0.16]）。平均随访50个月（36 SD）的利福沙星组和67个月（50 SD）的左氧氟沙星组（P = 0.36），治疗成功率分别为89%和87.5%（P = 0.89）。利福沙星组没有一例失败是由于利福平或利福沙星耐药的沙门氏菌。结论：我们的数据表明，利福沙星联合利福平是作为临床有效的左氧氟沙星/利福平由MSSA引起的早期急性PJI。(c)2017 Elsevier B. V.和国际化疗学会。All rights reserved.
Objectives: The combination of a fluoroquinolone with rifampin is one of the cornerstones in the treatment of prosthetic joint infections (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin-susceptible Staphylococcus aureus (MSSA) and, therefore, is an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with early acute PJI caused by MSSA treated with either moxifloxacin/rifampin or levofloxacin/rifampin.Methods: Medical files of patients treated with moxifloxacin/rifampin (University Medical Centre Groningen) or levofloxacin/rifampin (Hospital Clinic Barcelona) were retrospectively reviewed (2005-2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up.Results: Differences in baseline characteristics between the two cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C-reactive protein and Cemented prosthesis), were similar in the two groups (2.9 [1.5 SD] for the moxifloxacin group vs. 2.2 [1.2 SD] for the levofloxacin group [P = 0.16]). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (P = 0.36), treatment was successful in 89% vs. 87.5%, respectively (P = 0.89). None of the failures in the moxifloxacin group were due to rifampin-or moxifloxacin-resistant S. aureus strains.Conclusion: Our data indicate that moxifloxacin combined with rifampin is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA. (c) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.