Infectious Diseases, St. Louis VA Medical Center-John Cochran Division, St. Louis College of Pharmacy, St. Louis, MO 63110, USA.
Clin Ther. 2012 Jul;34(7):1521-7. doi: 10.1016/j.clinthera.2012.06.013. Epub 2012 Jun 29.
Osteomyelitis (OM) is a serious infection with high rates of recurrence. Vancomycin has been used for decades in the treatment of OM, but, despite adequate dosing, 30% to 50% of patients experience infection recurrence within 12 months. Daptomycin, a novel lipopetide antibiotic, is also active against resistant gram-positive organisms, but there is little published about its efficacy and tolerability in the treatment of OM.
Our aim was to compare the recurrence rates of OM in patients treated with daptomycin or vancomycin.
A retrospective cohort study of all patients at a VA Medical Center between January 1, 2003, and July 31, 2009, who received daptomycin for the treatment of OM was undertaken. Patients with a diagnosis of OM who received at least 2 weeks of daptomycin and had at least 1 follow-up visit within 6 months after completion of therapy were included. Each patient was matched with 2 controls treated with at least 2 weeks of vancomycin for OM. Matching criteria included previous OM, diabetes, peripheral vascular disease, hardware involvement, and surgical therapy. Patients were excluded from the evaluation if they received <14 days of therapy, had no follow-up in the 6 months after therapy was discontinued, had an absolute neutrophil count <500 cells/mm(3), or were receiving vancomycin and daptomycin concurrently. The primary outcome was recurrence of infection within 6 months after the discontinuation of therapy. Secondary outcomes included mean change in creatine phosphokinase (CPK), incident thrombocytopenia, and mean doses of antibiotics. The χ(2) test was used to compare rates of recurrence between groups.
Seventeen patients received at least 2 weeks of daptomycin for the treatment of OM and were matched to 34 vancomycin controls. Twenty-nine percent of patients receiving daptomycin had a recurrence of infection compared with 61.7% in the vancomycin group (P = 0.029). The mean change in CPK for the daptomycin group was +28.8 U/L. No thrombocytopenia developed in any patients receiving daptomycin compared with 2 (5.9%) patients in the vancomycin group.
In a limited number of cases, significantly fewer patients treated with daptomycin for OM had a recurrence of their infection. Daptomycin may be a tolerable and effective alternative to vancomycin for the treatment of OM.
骨髓炎（OM）是一种严重的感染，其复发率很高。万古霉素已在骨髓炎的治疗中使用了数十年，但尽管剂量充足，仍有 30%至 50%的患者在 12 个月内出现感染复发。达托霉素是一种新型脂肽抗生素，对耐药革兰阳性菌也具有活性，但关于其在骨髓炎治疗中的疗效和耐受性的研究很少。
我们旨在比较达托霉素和万古霉素治疗骨髓炎患者的复发率。
对 2003 年 1 月 1 日至 2009 年 7 月 31 日期间在退伍军人事务医疗中心接受达托霉素治疗骨髓炎的所有患者进行了回顾性队列研究。纳入至少接受 2 周达托霉素治疗且在治疗结束后 6 个月内至少有 1 次随访的骨髓炎诊断患者。每位患者均与 2 名接受至少 2 周万古霉素治疗骨髓炎的对照患者匹配。匹配标准包括既往骨髓炎、糖尿病、外周血管疾病、内置物和手术治疗。如果患者接受治疗的时间<14 天、治疗停止后 6 个月内无随访、绝对中性粒细胞计数<500 个/mm(3)或同时接受万古霉素和达托霉素治疗，则将其从评估中排除。主要结局是治疗停止后 6 个月内感染复发。次要结局包括肌酸磷酸激酶（CPK）的平均变化、血小板减少症的发生率和抗生素的平均剂量。采用 χ(2)检验比较两组之间的复发率。
17 名患者接受至少 2 周的达托霉素治疗骨髓炎，并与 34 名万古霉素对照患者相匹配。接受达托霉素治疗的患者中有 29%（5/17）出现感染复发，而万古霉素组有 61.7%（22/36）（P=0.029）。达托霉素组的 CPK 平均变化为+28.8 U/L。与万古霉素组的 2 名（5.9%）患者相比，没有任何接受达托霉素治疗的患者出现血小板减少症。
在少数情况下，接受达托霉素治疗骨髓炎的患者感染复发的比例明显较低。达托霉素可能是治疗骨髓炎的一种可耐受且有效的万古霉素替代药物。
