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題名 | 萬古黴素治療MRSA引起MIC值上升=Vancomycin Minimal Inhibitory Concentration Elevated in a MRSA Patient |
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作者 | 陳秋如; 項怡平; 李炳鈺; 鄭奕帝; 李志雄; | 書刊名 | 藥學雜誌 |
卷期 | 29:2=115 2013.06[民102.06] |
頁次 | 頁65-71 |
分類號 | 418.281 |
關鍵詞 | 萬古黴素; 抗藥性金黃色葡萄球菌; 波谷值; Vancomycin; MRSA; Trough level; |
語文 | 中文(Chinese) |
中文摘要 | MRSA遍佈醫院及社區,為近年來極被注意的一種致病菌。MRSA 的感染會導致患者的住院天數延長及醫療費用增加。近年來亦發現 MRSA 對 vancomycin 感受性降低,甚至已有產生抗藥性的菌株 (VRSA) 被報告。 本案例為一已接受定期血液透析治療的紅斑性狼瘡患者,因突然意識不清住院,住院後診斷為左側髖部敗血性關節炎合併血液培養報告為 MRSA。在接受 vancomycin 1 g 一星期兩次治療時,測得波谷值為14.02 mg/L,低於目標波谷值15-20 mg/L,且 MIC 爬升至2 mcg/mL;後改成 daptomycin 500 mg/vial 每2天1支,daptomycin 之 MIC 亦上升至3 mcg/mL;因此改成 linezolid 600 mg 每12小時一支合併 sodium fusidate 500 mg 每天三次,經治療18天後,血液培養報告已無 MRSA。此案例的 vancomycin 治療失敗除了劑量不適當,MIC 慢慢爬升導致抗藥性亦是原因之一。 |
英文摘要 | Methicillin-resistant Staphylococcus aureus (MRSA) is one of the noticeable pathogen and proliferates in the hospital and the community. MRSA may cause long hospital stay and high medical cost. MRSA reduced susceptibities to vancomycin as vancomycin-resistant Staphylococcus aureus (VRSA) recently. Here presented a 26-year-old female in-patient with a medical history of systemic lupus erythematosus (SLE) underwent hemodialysis for acute disturbance of consciousness. The diagnosis of septic arthritis with the MRSA (+) blood culture was reported after hospitalization. Initially, she was treated with vancomycin 1 g intravenous (IV) twice a week. The vancomycin trough level revealed 14.02 mg/L that was below target level 15 mg/L and minimal inhibitory concentration (MIC) elevated to 2 mcg/mL. When vancomycin shifted to daptomycin, MIC of daptomycin elevated to 3 mcg/mL. The combination therapy with linezolid 600 mg IV every 12 hours and sodium fusidate 500 mg orally three times a day were prescribed. After 18 day-treatment, there was no more MRSA (+) blood culture. The initial vancomycin treatment failure would be due to inappropriateness of dosing and MIC creeps among MRSA susceptible strains. Therefore, the appropriate vancomycin dosing for treating MRSA is important. |
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