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Abstract
Aim: We aimed to determine the relationship between teicoplanin use and increased minimal inhibitor concentrations of coagulase-negative staphylococci (CNS) isolated from catheter related bloodstream infections (CRBSI) in patients with hematological malignancies. Methods : The study was performed on CNS strains isolated from CRBSI of FN patients during the period between 2006-2010. Teicoplanin MICs were determined by using the Etest method. Demographic characteristics of patients, underlying hematological diseases, the dose and course of teicoplanin were recorded. Grams and international units of teicoplanin were further converted into defined daily doses (DDD). Results: A total of 72 CNS strains causing CRBSI isolated from FN attacks of the patients were analyzed. Among them, Staphylococcus. epidermidis (47%) and Staphylococcus haemolyticus (42%) were the most frequent CNS species. Oxacillin resistance was detected in 74% of all isolates. Increase in MIC values among CNS strains were detected in 44 patients (61%). Mean MIC value for teicoplanin among CNS strains before the treatment was 2.1±1.76 µg/ml, and it was 4.4±3.89 µg/ml after the treatment (p<0.001). Increase in MIC was found to be significantly higher among oxacillin-resistant strains than oxacillin-susceptible strains (p=0,03). A positive correlation was determined between DDD of teicoplanin and MIC increase among CNS strains (p=0.06). Conclusions: We detected an increase in teicoplanin MIC values of CNS isolated from catheter-related BSI related to teicoplanin consumption. The teicoplanin MIC increase was more prominent among oxacillin-resistant isolates. Teicoplanin should be used cautiously in the treatment of repeated CRBSI attacks caused by S. epidermidis and S. haemolyticus which occurred within 90 days after the previous attack.
Highlights
Catheter related bloodstream infections (CRBSI) caused by coagulasenegative staphylococci (CNS) are frequent in patients with febrile neutropenia (FN)
A total of 231 CNS strains isolated from CRBSI of 124 patients with hematological malignancies were analyzed in the study
Identification of strains revealed that S. epidermidis 34 (47%) and S. haemolyticus 30 (42%) were the most frequent CNS species
Summary
Catheter related bloodstream infections (CRBSI) caused by coagulasenegative staphylococci (CNS) are frequent in patients with febrile neutropenia (FN). Teicoplanin is preferred in the treatment of CRBSI in our center because of having less side effects and allowing for outpatient parenteral use. Decreased susceptibility to teicoplanin among CNS has been reported, especially in Staphylococcus haemolyticus and S. epidermidis, due to the excessive use of glycopeptides [1,2,3]. The treatment of CRBSI remains difficult, especially in febrile neutropenic patients infected with CNS, which has decreased susceptibility to teicoplanin. The increase in MIC levels of teicoplanin may cause treatment failure [4,5]. Monitoring MIC levels of teicoplanin among CNS isolates is needed, especially in those isolated from repeated episodes
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