Department of Internal Medicine, University of Naples S.U.N., Naples, Italy.
Clin Infect Dis. 2012 Feb 1;54(3):347-54. doi: 10.1093/cid/cir805. Epub 2011 Nov 18.
Cardiac implantable electronic device (CIED)-related endocarditis is a growing challenge because of increasing incidence and significant mortality. Current treatment is based on complete hardware removal coupled with long-term administration of effective and safe antimicrobials. Daptomycin at the dose of 6 mg/kg/day has been found to be effective in staphylococcal endocarditis, but limited data exist on CIED endocarditis. Moreover, whether higher doses could be more effective but equally safe in this setting is currently unknown.
We report here our experience with high-dose daptomycin in the treatment of 25 cases of CIED endocarditis due to staphylococci.
Patients were mostly elderly and male, with large lead vegetations and severe comorbidities. Pathogens were Staphylococcus epidermidis (56%), Staphylococcus aureus (28%), and other coagulase-negative staphylococci (16%). Only 4 patients (16%) had a normal pretreatment renal function. The median daptomycin daily dose was 8.3 mg/kg (range, 6.4-10.7). Daptomycin was administered for a median of 20 days (range, 8-52). Percutaneous lead extraction was performed in 88% of patients. Two patients (8%) failed to clear bacteremia. The overall clinical success of treatment was 80%, whereas a complete microbiological success was observed in 92% of patients. Creatine phosphokinase values were monitored and increased above normal in 5 cases (20%). No serious adverse event related to high-dose daptomycin was observed and no patient required discontinuation because of muscle toxicity.
Our experience suggests that high-dose daptomycin may be a safe therapeutic option in staphylococcal CIED endocarditis and may be associated with high microbiological responses and clinical success.
由于发病率的增加和显著的死亡率，与心脏植入式电子设备（CIED）相关的心内膜炎是一个日益严峻的挑战。目前的治疗方法是完全去除硬件，并长期使用有效和安全的抗生素。达托霉素的剂量为 6mg/kg/天已被证明对葡萄球菌心内膜炎有效，但在 CIED 心内膜炎方面的数据有限。此外，在这种情况下，更高的剂量是否更有效但同样安全，目前尚不清楚。
我们在此报告了我们使用高剂量达托霉素治疗 25 例由葡萄球菌引起的 CIED 心内膜炎的经验。
患者多为老年男性，有大的导丝赘生物和严重的合并症。病原体为表皮葡萄球菌（56%）、金黄色葡萄球菌（28%）和其他凝固酶阴性葡萄球菌（16%）。仅有 4 例患者（16%）的预处理肾功能正常。达托霉素的每日平均剂量为 8.3mg/kg（范围为 6.4-10.7）。达托霉素的平均使用时间为 20 天（范围为 8-52 天）。88%的患者进行了经皮导丝提取。有 2 例患者（8%）未能清除菌血症。总的治疗临床成功率为 80%，而 92%的患者完全清除了微生物。监测肌酸磷酸激酶值，有 5 例（20%）升高超过正常。未观察到与高剂量达托霉素相关的严重不良事件，也没有因肌肉毒性而需要停药的患者。
我们的经验表明，高剂量达托霉素可能是治疗葡萄球菌性 CIED 心内膜炎的一种安全治疗选择，并且可能与高微生物反应和临床成功相关。
