scholarly journals Successful Treatment of Community-Acquired Methicillin-Resistant Staphylococcus Aureus Necrotizing Pneumonia in the Setting of Chronic Graft-Versus-Host Disease

Cureus ◽  
2021 ◽  
Author(s):  
Kavita Renduchintala ◽  
Sowmya Nanjappa ◽  
Asha Ramsakal ◽  
John Greene
Keyword(s):  
Staphylococcus Aureus ◽  
Graft Versus Host Disease ◽  
Successful Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Necrotizing Pneumonia ◽  
Methicillin Resistant ◽  
Host Disease ◽  
Graft Versus Host

Rifampin–sirolimus–voriconazole interaction in a hematopoietic cell transplant recipient

2016 ◽  
Vol 23 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Justin A Wasko ◽  
James S Westholder ◽  
Pamala A Jacobson
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Interactions ◽  
Cell Transplantation ◽  
Graft Versus Host Disease ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Methicillin Resistant ◽  
Host Disease ◽  
Graft Versus Host

Purpose Patients undergoing hematopoietic cell transplantation are treated with multiple medications, potentially complicated by drug–drug interactions. Drug interactions with sirolimus, voriconazole, and rifampin are particularly difficult because of the complex and simultaneous enzyme inhibition and induction mechanisms. We report a hematopoietic cell transplantation patient receiving sirolimus and voriconazole who was given rifampin while being treated for presumed methicillin-resistant Staphylococcus aureus meningitis. Summary A 31 year-old female received a nonmyeloablative allogeneic umbilical cord hematopoietic cell transplantation for myelodysplastic syndrome transformed to acute myeloid leukemia (AML). Her graft versus host disease and antifungal prophylaxis included sirolimus and voriconazole, respectively. Therapeutic drug monitoring prior to admission revealed a stable outpatient sirolimus regimen of 0.4 mg orally daily (trough goal 3–12 mcg/L). She was admitted to the inpatient hematopoietic cell transplantation service and diagnosed with methicillin-resistant Staphylococcus aureus bacteremia and presumed bacterial meningitis 217 days after transplant. Intravenous rifampin and vancomycin were initiated and voriconazole was changed to micafungin. Sirolimus trough concentrations were undetectable two days after starting rifampin. Therapeutic sirolimus concentrations were achieved four days later, at a sirolimus dose of 16–18 mg orally daily. Rifampin was discontinued after nine days and the sirolimus dose was adjusted accordingly, maintaining therapeutic levels throughout follow-up. The patient suffered a flare of chronic skin graft versus host disease requiring etanercept, high-dose systemic steroids, and topical steroids. Conclusion To the best of our knowledge, this is the first report describing the management of sirolimus during the transition from voriconazole inhibition to rifampin induction. Clinicians should be aware of potential drug–drug interactions.

Severe Sepsis Attributable to Community-Associated Methicillin-Resistant Staphylococcus aureus: An Emerging Fatal Problem

2007 ◽  
Vol 73 (7) ◽  
pp. 684-687 ◽  
Author(s):  
Eric T. Castaldo ◽  
Edmund Y. Yang
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Soft Tissues ◽  
Hospital Admissions ◽  
Primary Source ◽  
Necrotizing Pneumonia ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Cardiorespiratory Failure ◽  
Source Of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

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