Teicoplanin as an anti-methicillin resistant staphylococcus aureus agent in infections of severely poisoned intensive care unit patients/Tehran- Iran

摘要

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is related to high morbidity and mortality. Teicoplanin is a semi synthetic glycopeptide antibiotic with a spectrum of activity similar to vancomycin. Our objective is the evaluation of efficacy and safety of Teicoplanin in MRSA infections among severely poisoned intensive care unit (ICU) patients. Methods: During a 6 months period, in a prospective cross sectional study, 54 eligible patients were recruited from among 80 who were clinically suspicious for MRSA infections. The efficacy and safety of Teicoplanin by loding dose of 6 mg/kg (maximum 400 mg per dose) for three loading doses 12 hours apart and then every 24 hours was evaluated 5 times. The clinical findings, laboratory data, and bacteriologic responses were categorized as cure, improvement and failure. Results: The mean(SD) age was 36.3(13.3) years. 75.9% were male. Suicidal attempts were recorded in 63%. The most common poisoning was TCAs, BZDs, tramadol and opium. 94.4% were unconscious and under mechanical ventilation. Tracheal cultures were positive in 98.1% by VAP diagnosis. ICU length of stay was between 4-54 days. Total clinical effectiveness was 90.4%, and failure 9.6%. Mortality rate was 9/54 (16.6 %). On the fourth visit, the adverse effects included: rash (11.10%), anemia (36.17%), nephrotoxicity (17.02%) and thrombocytopenia < 150000 (100%). Other side effects such as: leucopenia, severe thrombocytopenia (< 50000), pancytopenia and red man syndrome were not detected. Conclusions: Teicoplanin can be suggested for use in for MRSA infections among severely poisoned patient, based on its efficacy, safety, half life and tolerance, (www.actabiomedica.it)