Vancomycin-resistant enterococci (VRE) have recently emerged as an increasing concern in the management of severe infections. Treatment of these life-threatening infections has been limited to quinupristin-dalfopristin and, more recently, linezolid therapy. We report the first case, to our knowledge, of vancomycin-resistant Enterococcus faecium vertebral osteomyelitis treated successfully with quinupristin-dalfopristin. We review the recent epidemiology of VRE and briefly outline the pharmacology and pharmacokinetics of quinupristin-dalfopristin.
Multiple drug resistance is rapidly becoming an obstacle in the treatment of infection. The first reports of VRE appeared in the mid-1980s and since then have increased dramatically. To our knowledge, there have been no reported cases of vancomycin-resistant Enterococcus faecium osteomyelitis treated with quinupristin-dalfopristin (Synercid). However, a pharmaceutical company has reportedly treated 8 patients who had osteomyelitis and VRE, with only one failure recorded.*
Due to its intrinsic resistance, treatment of VRE osteomyelitis is extremely difficult and may require a combination of aggressive surgical debridement, hardware removal (at times), and appropriate antimicrobial therapy. We present a case of VRE (E faecium) osteomyelitis after decompressive laminectomy that was treated successfully with quinupristin-dalfopristin. The epidemiology and microbiology of VRE and the pharmacokinetics of quinupristin-dalfopristin are reviewed. Our case adds to the available data and suggests that quinupristin-dalfopristin is a useful drug in the management of these infections.
| * | Written communication, Maria Popp, RN, Adventis Pharmaceuticals, January 1999. |