达托霉素治疗儿童耐甲氧西林金黄色葡萄球菌骨关节感染合并血流感染分析OA

Objective To explore individualized treatment strategies for a pediatric patient with methicillin-resistant Staphylococcus aureus(MRSA)bone and joint infection(BJI)complicated by bloodstream infection(BSI).Methods A clin-ical pharmacist participated in the management of this pediatric case.By analyzing factors related to the infection site(penetra-tion),the pathogen,and the drug itself,the reasons for the suboptimal response were identified.Based on the pathogen profile,in-ternational guidelines,and pharmacokinetic principles,an evidence-based recommendation was provided to switch to a daptomycin regimen.Key issues for its individualized use in children,including dosage,therapeutic drug monitoring,and treatment duration,were discussed.Results In this pediatric case of MRSA BJI with BSI,the initial vancomycin therapy was assessed as ineffec-tive after 14 days.The clinical pharmacist identified potential contributing factors,including possible MRSA biofilm formation,van-comycin minimal inhibitory concentration(MIC)creep,insufficient drug penetration at the infection site,inadequate drug expo-sure,and a relatively delayed surgical drainage.Consequently,a switch to daptomycin(6 mg·kg-1 once daily)was recommended.This modified regimen led to a rapid clinical response,with fever resolution within 24 hours,followed by a steady decline in in-flammatory markers and negative blood cultures.After 2 weeks of daptomycin treatment,the patient's condition improved signifi-cantly,leading to discharge and full recovery.No drug-related adverse reactions were observed during the treatment course.Con-clusions ①Assessment approach:Response evaluation should extend beyond trough vancomycin levels to integrate pathogen MIC and infection site characteristics;②Treatment option:Daptomycin serves as an effective salvage therapy for pediatric MRSA BJI/BSI following vancomycin failure;③Implementation phase:A daptomycin dosage of 6 mg·kg-1 once daily,complemented by therapeutic drug monitoring and creatine kinase surveillance,can optimize efficacy and ensure safety.