Graduate Diploma of Clinical Pharmacy, UQ, 2012; Bachelor of Pharmacy, UQ, 2006
Nephrotoxicity of antibiotics in patients with Staphylococcus aureus bacteremia: incidence, mechanisms and outcomes
Amy Legg is an experienced clinical pharmacist in infectious diseases and antimicrobial stewardship. Her research interests include effects of penicillin allergy on patient outcomes and process for allergy assessment, therapeutic drug monitoring to ensure efficacy and safety, and uptake and efficacy of the hepatitis C medications.
Clinically significant nephrotoxicity has been reported when penicillin-based antibiotics (specifically piperacillin-tazobactam and flucloxacillin) are used in combination with vancomycin. These two drug classes in combination have been the mainstay of therapy for infections suspected to be caused by staphylococci, or for other serious infections such as febrile neutropenia, sepsis, and skin and soft tissue infections. However, the risk of nephrotoxicity has introduced uncertainty around their use in clinical practice. Despite this preliminary research suggesting potential adverse effects from the combination, data defining the toxicological mechanism, risk factors (including duration of therapy), clinical and biochemical progression and patient outcomes are largely unavailable. The role of Staphylococcus aureus itself in causing renal toxicity in this setting remains unknown. Additionally, the safety of alternative regimens (eg. cephalosporins in combination with vancomycin) has not been proven. This information is urgently needed to inform clinical practice.
- Barras, M., & Legg, A. (2017). Drug dosing in obese adults. Aust Prescr, 40(5), 189-193. doi:10.18773/austprescr.2017.053
- Stewart, A., Roberts, J. A., Wallis, S. C., Allworth, A. M., Legg, A., & McCarthy, K. L. (2018). Evidence of clinical response and stability of Ceftolozane/Tazobactam used to treat a carbapenem-resistant Pseudomonas Aeruginosa lung abscess on an outpatient antimicrobial program. Int J Antimicrob Agents, 51(6), 941-942. doi:10.1016/j.ijantimicag.2018.02.008
- O'Callaghan, K., Tapp, S., Hajkowicz, K., Legg, A., & McCarthy, K. L. (2019). Outcomes of patients with a history of injecting drug use and receipt of outpatient antimicrobial therapy. Eur J Clin Microbiol Infect Dis, 38(3), 575-580. doi:10.1007/s10096-018-03461-3
- Hung, T. Y., Janson, S., Smith, P., Legg, A., & Baird, R. W. (2019). Declining soil transmitted helminth detections in an Australian tropical region. Pathology, 51(7), 737-741. doi:10.1016/j.pathol.2019.09.002
- Legg, A., Halford, M., & McCarthy, K. (2020). Plasma concentrations resulting from continuous infusion of meropenem in a community-based outpatient program: A case series. Am J Health Syst Pharm, 77(24), 2074-2080. doi:10.1093/ajhp/zxaa319
- Parsonson, F., Legg, A., Halford, M., & McCarthy, K. (2020). Contemporaneous management of ampicillin infusions in the outpatient setting through the use of therapeutic drug monitoring. Int J Antimicrob Agents, 55(6), 105975. doi:10.1016/j.ijantimicag.2020.105975
- McCarthy, K. L., Harris-Brown, T., Smits, E. J., Legg, A., Chatfield, M. D., & Paterson, D. L. (2021). The MOBILISE study: utilisation of ambulatory pumps in the inpatient setting to administer continuous antibiotic infusions-a randomised controlled trial. Eur J Clin Microbiol Infect Dis. doi:10.1007/s10096-021-04294-3