Vol.72 No.2 March 2024
A case of MRSA bacteremia that was treated by subcutaneous teicoplanin administration owing to difficulty in securing a peripheral venous catheter
1)Department of Pharmacy, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka, Japan
2)Department of Infection Control, Shizuoka General Hospital
3)Department of Clinical Laboratory Medicine, Shizuoka General Hospital
Abstract
A 49-year-old female patient with Crohn's disease was admitted to the hospital for Miles' operation, partial resection of the small intestine (residual length of the small intestine post surgery, 110 cm), and drainage of an intraabdominal abscess. She received treatment with antimicrobial agents for approximately 6 weeks for the intra-abdominal abscess. On day 5 after completion of the antibiotic treatment course, she developed high fever (body temperature 39.9°C), erythema, and pus discharge at the site of insertion of the central venous catheter (CVC). Blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and we made a diagnosis of catheter-related bloodstream infection. The CVC was removed and treatment with intravenous vancomycin (VCM) was started. The patient received four weeks of antibiotic treatment for complicated MRSA bacteremia after blood cultures were negative; however, after three weeks of VCM therapy, since it became difficult to secure a peripheral venous catheter, the treatment was switched to subcutaneous teicoplanin (TEIC) until completion of a total of four weeks.
Oral linezolid (LZD) and subcutaneous TEIC are considered as alternatives to intravenous VCM for the treatment of infections caused by MRSA. We chose subcutaneous TEIC, considering the possibility of decreased absorption of LZD tablets due to the short residual length of the small intestine. The trough concentration of TEIC reached 37.7 μg/mL, an effective blood concentration, on day 4 after the start of treatment. Since pain and swelling at the site of subcutaneous infusion were mild, we believe that subcutaneous TEIC administration would be a useful an effective treatment alternative for MRSA infection.
Key word
teicoplanin, subcutaneous administration, MRSA, catheter-related bloodstream infection
Received
July 4, 2023
Accepted
November 6, 2023
Jpn. J. Chemother. 72 (2): 148-153, 2024
