Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Karadeniz Technical University, 61080, Trabzon, Turkey.
J Infect Chemother. 2013 Aug;19(4):698-702. doi: 10.1007/s10156-012-0546-9. Epub 2013 Jan 9.
The aim of this study was to evaluate the effectiveness of daptomycin in left-sided infective endocarditis (IE) patients. Fourteen patients with left heart endocarditis, monitored with a diagnosis of IE based on modified Duke criteria between July 2010 and May 2011, and receiving daptomycin as monotherapy, were enrolled. The success of daptomycin in these patients was revealed with improvements in microbiological, biochemical, and radiologic findings, as well as physical examination findings. Patient average age was 63.5 ± 14.2 years (36-80 years); 8 (57 %) were men and 6 (43 %) women. The pathogens methicillin-resistant Staphylococcus aureus (71.5 %), Streptococcus mutans (21.5 %), and methicillin-sensitive Staphylococcus aureus (7 %) were isolated from our patients. Daptomycin was used in initial treatment in 5 (36 %) patients; treatment was subsequently modified to daptomycin in 9 (64 %) patients as a consequence of drug serum level insufficiency, agent sensitivity to the drug administered, or drug side effects. Thirteen patients were discharged in a healthy condition, with successful surgical treatment in 5 (36 %). Only 1, an 80-year-old IE patient, was lost from advanced cardiac failure. No significant side effects were seen in any patient receiving daptomycin. The most frequent side effects were minimal rises in serum CPK levels during treatment; these values returned to normal after treatment. Daptomycin can be used successfully in left heart endocarditis with no significant side effects. Studies involving a wider patient series are now needed to support the use of daptomycin in left heart endocarditis.
本研究旨在评估达托霉素治疗左侧感染性心内膜炎（IE）患者的疗效。2010 年 7 月至 2011 年 5 月期间，根据改良的 Duke 标准监测到 14 例左心内膜炎患者，诊断为 IE，并接受达托霉素单药治疗。达托霉素在这些患者中的疗效通过微生物学、生化和影像学发现以及体检发现的改善来揭示。患者平均年龄为 63.5±14.2 岁（36-80 岁）；8 例（57%）为男性，6 例（43%）为女性。从我们的患者中分离出的病原体包括耐甲氧西林金黄色葡萄球菌（71.5%）、变形链球菌（21.5%）和甲氧西林敏感金黄色葡萄球菌（7%）。5 例（36%）患者在初始治疗中使用达托霉素；由于药物血清水平不足、药物对所给予药物的敏感性或药物副作用，9 例（64%）患者的治疗随后改为达托霉素。13 例患者健康出院，5 例（36%）患者成功进行了手术治疗。只有 1 例 80 岁的 IE 患者因晚期心力衰竭而失去。接受达托霉素治疗的患者均未出现明显副作用。最常见的副作用是治疗期间血清 CPK 水平略有升高；治疗后这些值恢复正常。达托霉素可成功用于无明显副作用的左心内膜炎。目前需要开展涉及更广泛患者系列的研究来支持达托霉素在左心内膜炎中的应用。
