Joseph Warren S, Quast Thomas, Cogo Alberto, Crompton Monica G, Yoon Min Jung, Lamp Kenneth C, Culshaw Darren, Chaves Ricardo L
Roxborough Memorial Hospital, Philadelphia, PA.
J Am Podiatr Med Assoc. 2014 Mar;104(2):159-68. doi: 10.7547/0003-0538-104.2.159.
Diabetic foot infection (DFI) is a serious, difficult-to-treat infection, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin has been the standard treatment for MRSA infection, but lower response rates in MRSA skin infections have been reported. This analysis assessed the outcome and safety of daptomycin therapy in patients with a DFI caused by MRSA.
Using the Cubicin Outcomes Registry and Experience and the European Cubicin Outcomes Registry and Experience (2006-2009), 79 patients with MRSA DFI were identified and included in this analysis.
In the 74 evaluable patients, daptomycin was administered at a median dose of 4.8 mg/kg primarily every 24 hours (85.1%) and for a median of 15.0 days. Overall, 77.0% of the patients (57 of 74) received initial therapy with activity against MRSA; however, of patients receiving daptomycin as second-line therapy (n = 31), only 45.2% were treated with an antibiotic agent active against MRSA. The overall clinical success and treatment failure rates were 89.2% and 10.8%, respectively. Success with daptomycin therapy was higher in patients who had surgery and in those whose initial therapy was daptomycin. Eleven patients had 14 adverse events, two of which were possibly related to daptomycin use and led to discontinuation.
In a large real-world cohort of patients with MRSA DFI, daptomycin therapy was shown to be generally well tolerated and effective. The use of an anti-MRSA antibiotic agent should be considered when implementing first-line antibiotic drug therapy for DFI in countries where MRSA is common to avoid inappropriate empirical treatment and potential negative effects on outcomes.
糖尿病足感染（DFI）是一种严重且难以治疗的感染，尤其是由耐甲氧西林金黄色葡萄球菌（MRSA）引起时。万古霉素一直是MRSA感染的标准治疗药物，但有报道称其在MRSA皮肤感染中的有效率较低。本分析评估了达托霉素治疗由MRSA引起的DFI患者的疗效和安全性。
利用 Cubicin 结果登记与经验以及欧洲 Cubicin 结果登记与经验（2006 - 2009 年），确定了 79 例 MRSA DFI 患者并纳入本分析。
在 74 例可评估患者中，达托霉素的中位剂量为 4.8 mg/kg，主要每 24 小时给药一次（85.1%），中位疗程为 15.0 天。总体而言，77.0%的患者（74 例中的 57 例）接受了针对 MRSA 的初始治疗；然而，在接受达托霉素作为二线治疗的患者（n = 31）中，只有 45.2%接受了对 MRSA 有效的抗生素治疗。总体临床成功率和治疗失败率分别为 89.2%和 10.8%。接受手术的患者以及初始治疗为达托霉素的患者使用达托霉素治疗的成功率更高。11 例患者出现了 14 次不良事件，其中 2 次可能与使用达托霉素有关并导致停药。
在一大群患有 MRSA DFI 的真实世界患者中，达托霉素治疗显示出总体耐受性良好且有效。在 MRSA 常见的国家，对 DFI 实施一线抗生素药物治疗时应考虑使用抗 MRSA 抗生素，以避免不恰当的经验性治疗以及对治疗结果产生潜在负面影响。
