Department of Pharmaceutical Services, Glendale Adventist Medical Center, Glendale, California 91206-4007, USA.
Clin Ther. 2011 Oct;33(10):1391-9. doi: 10.1016/j.clinthera.2011.09.007. Epub 2011 Oct 19.
Data comparing alternatives to vancomycin for the treatment of Staphylococcus aureus infections with vancomycin MIC >1 are lacking.
We evaluated outcomes of S aureus infections based on whether daptomycin or vancomycin was used as initial therapy at a single institution, where the majority of S aureus infections had vancomycin MICs of 2 mg/L.
A retrospective chart review was conducted at a 450-bed private acute care hospital. All patients >18 years of age who received initial vancomycin or daptomycin for at least 3 days to treat an S aureus infection between November 2006 and July 2008 were included. Patients with endocarditis, osteomyelitis, or a central nervous system infection and/or those being treated for an S aureus respiratory tract infection were excluded.
A total of 165 patients (median age 68 years, range 24-95 years; 56% male) were included: 57 (35%) received daptomycin and 108 (65%) received vancomycin; 78% had vancomycin MIC values of 2 mg/L. The median antibiotic-related length of stay was significantly shorter with daptomycin than with vancomycin (7.5 vs 10.0 days; P = 0.035). Relapse rates in the clinically evaluable population were 25% and 23% for daptomycin and vancomycin, respectively; for the subset with S aureus bacteremia with vancomycin MICs of 2 mg/L, rates were 0% (0/9 patients) and 26% (6/23 patients) for daptomycin and vancomycin, respectively (P = 0.089). Thirty-day all-cause mortality was 6% (10/165 patients) and did not differ significantly by treatment: 7% (4/57 patients) versus 6% (6/108 patients) for daptomycin and vancomycin, respectively (P = 0.708).
In this setting, in which the majority of S aureus infections had vancomycin MIC values of 2 mg/L, we found the median antibiotic-related length of stay to be significantly shorter with daptomycin than with vancomycin. Prospective studies are needed to determine whether daptomycin confers benefits over vancomycin in specific infection types under conditions that are unfavorable for vancomycin, such as higher vancomycin MICs.
缺乏比较治疗耐万古霉素金黄色葡萄球菌感染时万古霉素 MIC>1 时的替代药物的相关数据。
我们评估了在一家医疗机构中使用达托霉素或万古霉素作为初始治疗时金黄色葡萄球菌感染的结果，该机构中大多数金黄色葡萄球菌感染的万古霉素 MIC 值为 2mg/L。
在一家 450 张床位的私立急性护理医院进行回顾性图表审查。纳入 2006 年 11 月至 2008 年 7 月期间至少接受 3 天万古霉素或达托霉素初始治疗以治疗金黄色葡萄球菌感染的>18 岁患者。排除患有心内膜炎、骨髓炎或中枢神经系统感染和/或正在接受金黄色葡萄球菌呼吸道感染治疗的患者。
共纳入 165 例患者（中位年龄 68 岁，范围 24-95 岁；56%为男性）：57 例（35%）接受达托霉素治疗，108 例（65%）接受万古霉素治疗；78%的万古霉素 MIC 值为 2mg/L。达托霉素相关抗生素住院时间中位数明显短于万古霉素（7.5 天比 10.0 天；P=0.035）。在临床评估人群中，达托霉素和万古霉素的复发率分别为 25%和 23%；万古霉素 MIC 值为 2mg/L 的金黄色葡萄球菌菌血症亚组中，达托霉素和万古霉素的复发率分别为 0%（9/9 例）和 26%（6/23 例）（P=0.089）。30 天全因死亡率为 6%（165 例患者中有 10 例），治疗方式之间无显著差异：达托霉素组为 7%（4/57 例），万古霉素组为 6%（6/108 例）（P=0.708）。
在这种情况下，大多数金黄色葡萄球菌感染的万古霉素 MIC 值为 2mg/L，我们发现达托霉素相关抗生素住院时间中位数明显短于万古霉素。需要前瞻性研究来确定在对万古霉素不利的情况下（如万古霉素 MIC 值较高），达托霉素是否比万古霉素在特定感染类型中具有优势。
