Lora-Tamayo Jaime, Parra-Ruiz Jorge, Rodríguez-Pardo Dolors, Barberán José, Ribera Alba, Tornero Eduardo, Pigrau Carles, Mensa José, Ariza Javier, Soriano Alex
Department of Infectious Diseases, Hospital Univ. de Bellvitge, Universidad de Barcelona, Barcelona, Spain.
Department of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain.
Diagn Microbiol Infect Dis. 2014 Sep;80(1):66-71. doi: 10.1016/j.diagmicrobio.2014.05.022. Epub 2014 Jun 5.
We aimed to analyze the efficacy and safety of high doses of daptomycin (10 mg/kg/d) plus rifampin (D10 + R) for prosthetic joint infection (PJI). This was an observational retrospective multicenter study (2010-2012) including all patients with acute PJI by fluoroquinolone-resistant staphylococci managed with implant retention and D10 + R. Twenty cases were included: 2 (10%) were withdrawn due to toxicity, leaving 18 cases for efficacy evaluation: 13 (72%) women, age 79 years (range 58-90). Clinical failure was observed in 9 (50%) patients: in 5 cases, staphylococci were recovered (28% of microbiological failures); no modification of daptomycin-MIC was observed. These 18 cases were compared with 44 matched historical cases: failure rate was similar, but whereas in the historical series, failure occurred fundamentally during therapy, in the present series, it was recorded after discontinuation of antibiotics. In summary, D10 + R may be the initial treatment of choice for PJI by fluoroquinolone-resistant staphylococci managed with implant retention.
我们旨在分析高剂量达托霉素（10毫克/千克/天）联合利福平（D10+R）治疗人工关节感染（PJI）的疗效和安全性。这是一项观察性回顾性多中心研究（2010 - 2012年），纳入了所有耐氟喹诺酮葡萄球菌所致急性PJI且采用保留植入物并使用D10+R治疗的患者。共纳入20例患者：2例（10%）因毒性反应退出，剩余18例进行疗效评估：13例（72%）为女性，年龄79岁（范围58 - 90岁）。9例（50%）患者出现临床失败：5例培养出葡萄球菌（占微生物学失败的28%）；未观察到达托霉素最低抑菌浓度（MIC）的改变。将这18例患者与44例匹配的历史病例进行比较：失败率相似，但在历史病例组中，失败主要发生在治疗期间，而在本病例组中，失败记录在抗生素停用后。总之，D10+R可能是耐氟喹诺酮葡萄球菌所致PJI且采用保留植入物治疗时的初始首选治疗方案。
