Vol.55 No.3 May 2007
A case report of successful treatment of methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis after coronary artery bypass grafting (CABG) with high blood concentration of teicoplanin
1)Department of Pharmacy, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo, Nagasaki, Japan
2)Department of Pharmacy, Fukuoka University Chikushi Hospital
3)Department of Cardiovascular Surgery, Sasebo Chuo Hospital
Abstract
A 78-year-old woman with severe stenoses in all of three branches of the coronary artery underwent coronary artery bypass grafting. Cefozopran (CZOP) was administrated because it was diagnosed a mediastinitis on day 34th after surgey and also Klebsiella pneumoniae was detected from the mediastinal fluid. On day 39th after surgey, the microbial substitution was occurred, and methicillin-resistant Staphylococcus aureus (MRSA) was detected. In consideration of renal dysfunction, arbekacin and vancomycin were not used and teicoplanin (TEIC) alone was administered. We considered that the initial dosage recommended in the package insert exhibited little effect on severe MRSA mediastinitis and maintained TEIC blood trough levels at ≥20 μg/mL (400→200 mg/day) with therapeutic drug monitoring (TDM) during early administration. Clinical symptoms and test results improved to where MRSA was no longer detected. TEIC administration was halted on administration day 50.
TEIC administration at recommended doses of 5 to 10 μg/mL exhibits no effect on most MRSA-infected patients, and TEIC dosage and concentration should be reviewed. A new treatment option for MRSA mediastinitis is to maintain TEIC blood trough levels at 20 μg/mL or higher under positive TDM.
Key word
teicoplanin, TDM, mediastinitis, MRSA
Received
January 10, 2007
Accepted
March 9, 2007
Jpn. J. Chemother. 55 (3): 230-234, 2007
