‘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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    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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