Daptomycin for the treatment of infective endocarditis: results from a European registry

作者：Dohmen Pascal M^*; Guleri Achyut; Capone Alessandro; Utili Riccardo; Seaton R Andrew; Jose Gonzalez Ramallo Victor; Pathan Rashidkhan; Heep Markus; Chaves Ricardo L

来源：Journal of Antimicrobial Chemotherapy, 2013, 68(4): 936-942.

DOI：10.1093/jac/dks467

• Staphylococcus aureus
• lipopeptides
• Gram-positive infections
• clinical success

Objectives: Infective endocarditis (IE) is a complex infection associated with high mortality. Daptomycin, a cyclic lipopeptide antibiotic highly active against Gram-positive bacteria, has recently been incorporated into IE treatment guidelines. This retrospective analysis provides insights into the use of daptomycin in IE in the European Cubicin (R) Outcomes Registry Experience (EU-CORESM) between 2006 and 2010. %26lt;br%26gt;Patients and methods: Three hundred and seventy-eight (10%) of 3621 enrolled patients received daptomycin for treatment of IE. Two hundred and fifty-nine (69%) had left-sided IF (LIE) and 182 patients (48%) underwent concomitant surgery. %26lt;br%26gt;Results: Staphylococcus aureus was the most frequently identified pathogen (n=92; methicillin susceptible, n=50) and daptomycin was used empirically in 134 patients. Among cases of second-line therapy (n=312), the most common reason for switching to daptomycin was failure of the previous regimen (including glycopeptides and penicillins). Daptomycin was administered at 6 mg/kg in 224 patients and at %26gt;= 8 mg/kg in 72 patients. Clinical success rates were 80% overall, 91% for right-sided IE (RIE) and 76% for LIE, with similar rates seen for infections caused by methicillin-susceptible S. aureus (84%) and methicillin-resistant S. aureus (81%). The clinical success rate in patients treated with %26gt;= 8 mg/kg daptomycin was 90% [n=72 (RIE, 91%; LIE, 89%)]. No new safety signals were observed. %26lt;br%26gt;Conclusions: In patients with IE registered in EU-CORE, daptomycin was most frequently used as second-line treatment after treatment failure. The majority of patients had LIE and most commonly received daptomycin for the treatment of staphylococcal infections. Clinical success was high in this difficult-to-treat population. The role of doses %26gt;= 8 mg/kg per day in the empirical treatment of IE deserves further investigation.

• 出版日期2013-4