Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil.
Braz J Infect Dis. 2013 Nov-Dec;17(6):647-53. doi: 10.1016/j.bjid.2013.03.005. Epub 2013 Jul 31.
To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes.
This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011) to collect data on 120 patients (44 patients in the first year and 76 patients in the second year) who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection.
Right-sided endocarditis (15.8%), complicated skin and soft tissue infections (cSSTI)-wound (15.0%) and bacteremia-catheter-related (14.2%) were the most frequent primary infections; lung (21.7%) was the most common site for infection. Daptomycin was used empirically in 76 (63.3%) patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the most common suspected pathogen (86.1%). 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively). The most common daptomycin dose administered for bacteremia and cSSTI was 6mg/kg (30.6%) and 4mg/kg (51.7%), respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1%) did not receive daptomycin while in intensive care unit. Carbapenem (22.5%) was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median) following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%), switched therapy (11.7%), and treatment failure (4.2%). Daptomycin demonstrated a favorable safety and tolerability profile regardless of treatment duration.
Daptomycin had a relevant role in the treatment of Gram-positive infections in the clinical practice setting in Brazil.
收集巴西严重革兰阳性菌感染患者使用达托霉素的非控制处方使用情况及其影响的数据，以及评估其疗效和安全性结局。
这是一项多中心、回顾性、非干预性登记研究（2009 年 8 月 1 日至 2011 年 6 月 30 日），共纳入 120 例在巴西接受至少一剂商业达托霉素治疗严重革兰阳性菌感染的患者（第 1 年 44 例，第 2 年 76 例）。
右侧心内膜炎（15.8%）、伴有伤口的复杂性皮肤和软组织感染（cSSTI）（15.0%）和菌血症-导管相关（14.2%）是最常见的原发性感染；肺部（21.7%）是最常见的感染部位。经验性使用达托霉素治疗的患者有 76 例（63.3%），最常见的疑似病原体是耐甲氧西林金黄色葡萄球菌（MRSA）（86.1%）。82.5%的培养物在开始达托霉素治疗前或治疗后不久获得。凝固酶阴性葡萄球菌、MRSA 和甲氧西林敏感金黄色葡萄球菌是最常鉴定到的病原体（分别占 23.8%、23.8%和 12.5%）。菌血症和 cSSTI 患者中最常使用的达托霉素剂量分别为 6mg/kg（30.6%）和 4mg/kg（51.7%）。住院患者达托霉素治疗的中位时间为 14 天。大多数患者（57.1%）在重症监护病房时未接受达托霉素治疗。碳青霉烯类药物（22.5%）是最常联合使用的抗生素。患者在开始达托霉素治疗后 2 天（中位时间）内显示出临床改善。临床治愈率为 80.8%，总治疗失败率为 10.8%。达托霉素停药的主要原因是治疗成功（75.8%）、转换治疗（11.7%）和治疗失败（4.2%）。无论治疗持续时间如何，达托霉素均具有良好的安全性和耐受性。
达托霉素在巴西的临床实践中对革兰阳性菌感染的治疗具有重要作用。
