Lalani T, Boucher H W, Cosgrove S E, Fowler V G, Kanafani Z A, Vigliani G A, Campion M, Abrutyn E, Levine D P, Price C S, Rehm S J, Corey G R, Karchmer A W
Division of Infectious Diseases, Duke Clinical Research Institute, Durham, NC, USA.
J Antimicrob Chemother. 2008 Jan;61(1):177-82. doi: 10.1093/jac/dkm437. Epub 2007 Nov 13.
To evaluate the clinical characteristics, treatment and outcomes of patients with osteoarticular infections (OAIs) associated with Staphylococcus aureus bacteraemia (SAB).
The clinical characteristics and outcomes for patients with OAI were described using a post hoc analysis of an open label, randomized trial comparing daptomycin with standard therapy (vancomycin or anti-staphylococcal penicillin with initial gentamicin) for the treatment of SAB.
OAI occurred in 32 of 121 patients (21 daptomycin and 11 standard therapy) with complicated SAB (18 septic arthritis, 9 vertebral osteomyelitis and 7 others). Two patients had osteomyelitis in more than one site. Success rates seen in two groups were as follows: vertebral osteomyelitis [3/5 (60%) daptomycin versus 0/2 (0%) comparator], septic arthritis [7/11 (64%) versus 3/5 (60%)], sternal osteomyelitis [3/3 (100%) versus 1/2 (50%)] and long bone osteomyelitis [0/1 (0%) versus 1/1 (100%)]. Success rates in both treatment groups improved with surgical therapy. Creatine phosphokinase elevations to >500 IU/L occurred in one patient on daptomycin who discontinued therapy, whereas renal impairment developed in three patients on standard therapy, two of whom discontinued therapy. Two patients treated with daptomycin and one patient on vancomycin had increases in S. aureus MICs to daptomycin and vancomycin, respectively. Three patients treated with daptomycin died following completion of therapy, with mortality attributed to multiple co-morbid conditions and inadequate debridement of OAIs in these patients. No deaths were reported in the standard therapy group.
Daptomycin may be considered an alternative to standard therapy in the treatment of patients with complicated SAB and OAI.
评估与金黄色葡萄球菌菌血症（SAB）相关的骨关节炎感染（OAI）患者的临床特征、治疗方法及预后。
通过对一项开放标签随机试验进行事后分析，描述OAI患者的临床特征及预后。该试验比较了达托霉素与标准疗法（万古霉素或抗葡萄球菌青霉素联合初始庆大霉素）治疗SAB的效果。
121例复杂SAB患者中有32例发生OAI（21例接受达托霉素治疗，11例接受标准疗法）（1�例为化脓性关节炎，9例为椎体骨髓炎，7例为其他类型）。2例患者存在一个以上部位的骨髓炎。两组的成功率如下：椎体骨髓炎[达托霉素组3/5（60%），对照剂组0/2（0%）]，化脓性关节炎[7/11（64%）对3/5（60%）]，胸骨骨髓炎[3/3（1oo%）对1/2（50%）]，长骨骨髓炎[0/1（0%）对1/1（100%）]。手术治疗使两个治疗组的成功率均有所提高。1例接受达托霉素治疗的患者肌酸磷酸激酶升高至>500 IU/L并停药，而3例接受标准疗法的患者出现肾功能损害，其中2例停药。2例接受达托霉素治疗的患者和1例接受万古霉素治疗的患者，金黄色葡萄球菌对达托霉素和万古霉素的最低抑菌浓度分别升高。3例接受达托霉素治疗的患者在治疗结束后死亡，死亡原因是多种合并症以及这些患者OAI清创不充分。标准疗法组未报告死亡病例。
在治疗复杂SAB和OAI患者时，达托霉素可被视为标准疗法的替代方案。
