‘The year of living dangerously’: successful Rhodococcus equi therapy in an immunosuppressed patient with minimal toxicity by one year of continuous intravenous vancomycin therapy combined with oral levofloxacin and rifampicin
  • Miguel Franco-Álvarez
    Internal Medicine Department, University Clinical Hospital, Santiago de Compostela, Spain
  • Iván Fernández-Castro
    Internal Medicine Department, University Clinical Hospital, Santiago de Compostela, Spain
  • Mariño Francisco Fernández Cambeiro
    Internal Medicine Department, University Clinical Hospital, Santiago de Compostela, Spain
  • Carmen Beceiro Abad
    Home Hospitalisation Unit, University Clinical Hospital, Santiago de Compostela, Spain
  • Esteban Otero Antón
    Internal Medicine Department, University Clinical Hospital, Santiago de Compostela, Spain
  • Sandra Rodríguez López
    Home Hospitalisation Unit, University Clinical Hospital, Santiago de Compostela, Spain
  • María Dolores Calvo Barbeito
    Home Hospitalisation Unit, University Clinical Hospital, Santiago de Compostela, Spain
  • Ignacio Novo-Veleiro
    Home Hospitalisation Unit, University Clinical Hospital, Santiago de Compostela, Spain

Keywords

Vancomycin, domiciliary antibiotic continuous infusion, Rhodococcus equi, home hospitalisation, immunocompromised patient

Abstract

Background: Rhodococcus equi is a Gram-positive microorganism that causes infections, particularly in immunocompromised patients. Treatment duration can be prolonged. While vancomycin is an effective drug in this scenario, its use may lead to renal damage. Studies have shown that continuous vancomycin infusion appears to be a safe strategy in terms of adverse effects compared to bolus administration.
Case description: We present the case of a 71-year-old female liver transplant recipient. After being diagnosed with a mediastinal infection caused by Rhodococcus equi with poor response to initial therapy, she required 12 months of continuous intravenous domiciliary infusion of vancomycin combined with oral levofloxacin and rifampicin. There was no drug-related complication throughout the follow-up.
Conclusions: The use of continuous vancomycin infusion has emerged as a safer, more efficient, and cost-effective alternative to intermittent administration. We want to emphasise the uniqueness of this case, where despite the unprecedented treatment duration, no adverse effects occurred.

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References

  • Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. Lancet Infect Dis 2010;10:350–359.
  • Gundelly P, Suzuki Y, Ribes JA, Thornton A. Differences in Rhodococcus equi infections based on immune status and antibiotic susceptibility of clinical isolates in a case series of 12 patients and cases in the literature. BioMed Res Int 2016; 2016:2737295.
  • Monteiro JF, Hahn SR, Gonçalves J, Fresco P. Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations. Pharmacol Res Perspect 2018;6:e00420.
  • Connors KP. Optimizing antibiotic pharmacodynamics for clinical practice. Pharm Anal Acta 2013;4:1-8.
  • van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013;57:734–744.
  • Ingram PR, Lye DC, Fisher DA, Goh W-P, Tam VH. Nephrotoxicity of continuous versus intermittent infusion of vancomycin in outpatient parenteral antimicrobial therapy. Int J Antimicrob Agents 2009;34:570–574.
  • Álvarez R, López Cortés LE, Molina J, Cisneros JM, Pachón J. Optimizing the clinical use of vancomycin. Antimicro Agents Chemother 2016;60:2601–2609.
  • Flannery AH, Bissell BD, Bastin MT, Morris PE, Neyra JA. Continuous versus intermittent infusion of vancomycin and the risk of acute kidney injury in critically ill adults: a systematic review and meta-analysis. Crit Care Med 2020;48:912–918.
  • Thijs L, Quintens C, Vander Elst L, De Munter P, Depypere M, Metsemakers W-J, et al. Clinical efficacy and safety of vancomycin continuous infusion in patients treated at home in an outpatient parenteral antimicrobial therapy program. Antibiotics (Basel) 2022;11:702.
  • Scarano M, D’Arrigo S, De Letteriis S, Grasso S, Pittiruti M, Scoppettuolo G. Risk of thrombophlebitis associated with continuous peripheral infusion of vancomycin: the effect of dilution. J Vasc Access 2022;11297298221095778.

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    Published: 2024-01-12
    Issue: 2024: Vol 11 No 2 (view)

    How to cite:
    1.
    Franco-Álvarez M, Fernández-Castro I, Fernández Cambeiro MF, Beceiro Abad C, Otero Antón E, Rodríguez López S, Calvo Barbeito MD, Novo-Veleiro I. ‘The year of living dangerously’: successful Rhodococcus equi therapy in an immunosuppressed patient with minimal toxicity by one year of continuous intravenous vancomycin therapy combined with oral levofloxacin and rifampicin. EJCRIM 2024;11 doi:10.12890/2024_004249.

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