Oklahoma State University Center for Health Sciences, Tulsa, OK 74127, USA.
Ann Pharmacother. 2010 Apr;44(4):746-9. doi: 10.1345/aph.1M650. Epub 2010 Mar 2.
To report on 6 weeks of daptomycin treatment for tricuspid valve endocarditis caused by Staphylococcus aureus in a pregnant female in her second trimester.
A 24-year-old, 14-week pregnant patient with no significant medical history, but with a history of intravenous drug abuse presented with tricuspid valve endocarditis caused by methicillin-sensitive S. aureus. After initial treatment with vancomycin, the patient continued to have fever and bacteremia and was initiated on daptomycin 6 mg/kg for 6 weeks of therapy. The treatment resulted in the resolution of the endocarditis, and no adverse sequelae were identified in the mother or baby.
Infective endocarditis is a common infection encountered in the hospital setting and represents an increased cost burden to institutions due to prolonged lengths of treatment. Antimicrobial resistance, antimicrobial failure, inadequate attainment of effective drug concentrations, drug allergies, and adverse reactions may be factors that limit the use of commonly utilized antimicrobial agents. Therefore, newer therapies like daptomycin may need to be employed in these situations. Although daptomycin is pregnancy category B, limited case reports with neonatal outcomes are reported.
This case provides further support for the safety of daptomycin in pregnancy with the dose of 6 mg/kg, the extended duration of therapy (6 weeks), and the primary exposure in the second trimester.
报告 6 周的达托霉素治疗妊娠中期耐甲氧西林金黄色葡萄球菌引起的三尖瓣心内膜炎的病例。
一名 24 岁、14 周妊娠的患者，无重大病史，但有静脉吸毒史，患有耐甲氧西林敏感金黄色葡萄球菌引起的三尖瓣心内膜炎。在初始万古霉素治疗后，患者仍有发热和菌血症，并开始使用达托霉素 6mg/kg，进行 6 周的治疗。治疗后心内膜炎得到缓解，母亲和婴儿均未出现不良后遗症。
感染性心内膜炎是医院环境中常见的感染，由于治疗时间延长，给医疗机构带来了更高的成本负担。抗菌药物耐药性、抗菌药物治疗失败、无法达到有效的药物浓度、药物过敏和不良反应等因素可能限制了常用抗菌药物的使用。因此，在这些情况下可能需要使用新型治疗方法，如达托霉素。虽然达托霉素属于妊娠 B 类药物，但报告的新生儿结局的有限病例报告。
该病例进一步支持在妊娠中使用达托霉素的安全性，剂量为 6mg/kg，治疗时间延长（6 周），且主要暴露在妊娠中期。
