Gallagher Jason C, Perez Mirza E, Marino Elizabeth A, LoCastro Laura G, Abrardo Lauren A, MacDougall Conan
School of Pharmacy, Temple University, Philadelphia, Pennsylvania 19140, USA.
Pharmacotherapy. 2009 Jul;29(7):792-9. doi: 10.1592/phco.29.7.792.
To determine clinical and microbiologic outcomes of daptomycin for the treatment of bacteremia caused by vancomycin-resistant enterococci (VRE).
Retrospective medical record review.
Academic tertiary care hospital.
Thirty patients (median age 59 yrs, range 19-79 yrs, 50% male) who received daptomycin for the treatment of VRE bacteremia between January 2004 and July 2007.
Patients were included if they received daptomycin and had a blood culture positive for VRE at the time daptomycin was started. The primary end point was microbiologic cure, defined as negative blood cultures for VRE at the end of therapy. Secondary outcomes were clinical outcomes, adverse events, and occurrence of elevated creatine kinase levels. Clinical outcomes were judged as positive, negative, or indeterminate. The median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17 (range 7-34), and 20 patients (67%) were in the intensive care unit. Patients received daptomycin for a median of 13 days (range 1-42 days), and the median dose administered was 6 mg/kg (range 3.7-8 mg/kg). Microbiologic cure was achieved in 24 patients (80%), and clinical success occurred in 17 patients (59% [one patient had an indeterminate clinical outcome and was excluded from this analysis]). All patients with a positive clinical outcome had microbiologic cure, six patients who died had microbiologic cure, and all patients with microbiologic failure died. On multivariable logistic regression, higher APACHE II score was associated with a lower chance of microbiologic success (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.56-0.95). Lower APACHE II score (AOR 0.86, 95% CI 0.74-1.0) and daptomycin dose of 6 mg/kg or more (AOR 7.29, 95% CI 1.02-52.0) were associated with clinical success. Adverse drug events possibly attributable to daptomycin were uncommon. Three patients had fever possibly related to daptomycin, and two patients had mild elevations of creatine kinase level.
Our experience suggests that daptomycin may be an acceptable option for VRE bacteremia; however, larger studies should be performed before this antimicrobial is routinely used for this indication.
确定达托霉素治疗耐万古霉素肠球菌（VRE）所致菌血症的临床和微生物学转归。
回顾性病历审查。
学术性三级医疗中心。
2004年1月至2007年7月间接受达托霉素治疗VRE菌血症的30例患者（中位年龄59岁，范围19 - 79岁，50%为男性）。
纳入在开始使用达托霉素时血培养VRE阳性且接受达托霉素治疗的患者。主要终点为微生物学治愈，定义为治疗结束时VRE血培养阴性。次要转归为临床转归、不良事件及肌酸激酶水平升高的发生情况。临床转归判定为阳性、阴性或不确定。急性生理与慢性健康状况评估（APACHE）II评分中位数为17（范围7 - 34），20例患者（67%）入住重症监护病房。患者接受达托霉素治疗的中位时间为13天（范围1 - 42天），给药中位剂量为6mg/kg（范围3.7 - 8mg/kg）。24例患者（80%）实现微生物学治愈，17例患者临床成功（59%[1例患者临床转归不确定，排除在本分析之外]）。所有临床转归阳性的患者均实现微生物学治愈，6例死亡患者实现微生物学治愈，所有微生物学治疗失败的患者均死亡。多因素逻辑回归分析显示，较高的APACHE II评分与微生物学成功的可能性较低相关（校正比值比[AOR]0.73，95%置信区间[CI]0.56 - 0.95）。较低的APACHE II评分（AOR 0.86，95%CI 0.74 - 1.0）和达托霉素剂量6mg/kg或更高（AOR 7.29，95%CI 1.02 - 52.0）与临床成功相关。可能归因于达托霉素的药物不良事件并不常见。3例患者发热可能与达托霉素有关，2例患者肌酸激酶水平轻度升高。
我们的经验表明，达托霉素可能是治疗VRE菌血症的一个可接受选择；然而，在该抗菌药物常规用于此适应证之前，应开展更大规模的研究。
