Holtom Paul D, Zalavras Charalampos G, Lamp Kenneth C, Park Nami, Friedrich Lawrence V
University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Clin Orthop Relat Res. 2007 Aug;461:35-9. doi: 10.1097/BLO.0b013e3181123bc5.
We retrospectively reviewed 25 patients with foot or ankle osteomyelitis reported to a registry who were treated with daptomycin. The patients' clinical experience was analyzed and described at a median dose of 6 mg/kg (range, 4-6.2 mg/kg) and a median duration of 38 days (range, 6-59 days). Twenty-three patients received daptomycin as secondary or tertiary therapy, primarily for not responding to their prior antibiotic therapy (n = 15). Concomitant antibiotics were given to 11 patients, mostly for Gram-negative and/or anaerobic coverage. Methicillin-resistant Staphylococcus aureus was the most common pathogen overall (15 of 25 patients). The median followup interval was 9 weeks (range, 0.5-77 weeks). Outcomes at the end of therapy were 16 patients' symptoms resolved, eight patients improved, and one patient did not respond to therapy; at followup, 19 patients' symptoms resolved, three patients improved, and three patients did not respond to therapy. Ongoing antibiotics were given to 52% of patients for a minimum of 8 days (median, 30 days; range, 8-232 days). Four patients with an implant (all removed) were successfully treated. Daptomycin appears promising for foot and ankle osteomyelitis caused by Gram-positive bacteria. Prospective, controlled clinical trials of daptomycin for osteomyelitis are warranted.
我们回顾性分析了登记在册的25例接受达托霉素治疗的足踝部骨髓炎患者。分析并描述了这些患者的临床情况，其中位剂量为6mg/kg（范围4 - 6.2mg/kg），中位疗程为38天（范围6 - 59天）。23例患者接受达托霉素作为二线或三线治疗，主要原因是对先前的抗生素治疗无反应（n = 15）。11例患者联合使用了抗生素，主要用于覆盖革兰阴性菌和/或厌氧菌。耐甲氧西林金黄色葡萄球菌是总体上最常见的病原体（25例患者中有15例）。中位随访时间为9周（范围0.5 - 77周）。治疗结束时，16例患者症状缓解，8例患者病情改善，1例患者治疗无反应；随访时，19例患者症状缓解，3例患者病情改善，3例患者治疗无反应。52%的患者持续使用抗生素至少8天（中位时间30天；范围8 - 232天）。4例有植入物的患者（均已取出）均成功治愈。达托霉素对于革兰阳性菌引起的足踝部骨髓炎似乎很有前景。有必要开展达托霉素治疗骨髓炎的前瞻性对照临床试验。
