Background: Staphylococci represent the first etiologic agents of bone and joint infection (BJI), leading\nglycopeptides use, especially in case of methicillin-resistance or betalactam intolerance. Teicoplanin may represent\nan alternative to vancomycin because of its acceptable bone penetration and possible subcutaneous\nadministration.\nMethods: Adults receiving teicoplanin for S. aureus BJI were included in a retrospective cohort study investigating\nintravenous or subcutaneous teicoplanin safety and pharmacokinetics.\nResults: Sixty-five S. aureus BJIs (orthopedic device-related infections, 69 %; methicillin-resistance, 17 %) were\ntreated by teicoplanin at the initial dose of 5.7 mg/kg/day (IQR, 4.7ââ?¬â??6.5) after a loading dose of 5 injections 12 h\napart. The first trough teicoplanin level (Cmin) reached the therapeutic target (15 mg/L) in 26 % of patients, only. An\noverdose (Cmin >25 mg/L) was observed in 16 % patients, 50 % of which had chronic renal failure (p = 0.049). Seven\nadverse events occurred in 6 patients (10 %); no predictive factor could be highlighted. After a 91-week follow-up\n(IQR, 51ââ?¬â??183), 27 treatment failures were observed (42 %), associated with diabetes (OR, 5.1; p = 0.057), systemic\ninflammatory disease (OR, 5.6; p = 0.043), and abscess (OR, 4.1; p < 10âË?â??3). A normal CRP-value at 1 month was\nprotective (OR, 0.2; p = 0.029). Subcutaneous administration (n = 14) showed no difference in pharmacokinetics and\ntolerance compared to the intravenous route.\nConclusions: Teicoplanin constitutes a well-tolerated therapeutic alternative in S. aureus BJI, with a possible\nsubcutaneous administration in outpatients. The loading dose might be increase to 9ââ?¬â??12 mg/kg to quickly reach\nthe therapeutic target, but tolerance of such higher doses remains to be evaluated, especially if using the\nsubcutaneous route.
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