Açar Burak, Tezer Tekçe Yasemin, Yayla Çağrı, Ünal Sefa, Ertem Ahmet Göktuğ, Şentürk Bihter, Özcan Çelebi Özlem, Aydoğdu Sinan
Department of Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2017 Jun;45(4):310-315. doi: 10.5543/tkda.2017.60784.
Infective endocarditis (IE) carries a high risk of cardiac morbidity and mortality, despite advances in the contemporary armamentarium. Along with the development of antibiotic resistant strains, research focusing on the efficacy of novel agents other than standard antibiotic regimens continues. Daptomycin, one of these antibiotics, is approved for the treatment of Staphylococcus bacteremia and right-sided endocarditis. This retrospective study was an investigation of the effectiveness of daptomycin in patients with left-sided IE.
Fourteen patients (mean age 50.9±16.5; range 24 to 70 years) with the diagnosis of left-sided IE based on modified Duke criteria received daptomycin as monotherapy. Outcome was evaluated according to clinical improvement, microbiological eradication, and in-hospital mortality.
Blood culture was positive in 13 patients (92.8%) and staphylococci were isolated in all but 1 patient (92.3%). Daptomycin was administered as monotherapy at a dose of 6 or 8 mg/kg/day for mean of 40.6±4.4 days. Clinical recovery rate was 71.4% and microbiological eradication rate was 85.7%. Mean duration of clinical recovery was 8.7±3.2 days and duration of microbiological eradication was 11.1±3.6 days. Side effects developed in 6 patients, but drug discontinuation was not required in any patient. Ten patients improved without complications. Two patients were lost due to heart failure and multiple-organ failure while treatment was continuing, and 2 patients died in early cardiac postoperative period.
Daptomycin is an effective and safe alternative to standard antibiotic therapy for the treatment of left-sided IE.
尽管现代医疗手段有所进步，但感染性心内膜炎（IE）仍具有较高的心脏发病和死亡风险。随着抗生素耐药菌株的出现，针对标准抗生素治疗方案以外新型药物疗效的研究仍在继续。达托霉素是其中一种抗生素，已被批准用于治疗葡萄球菌血症和右侧心内膜炎。本回顾性研究旨在调查达托霉素对左侧IE患者的疗效。
根据改良的杜克标准诊断为左侧IE的14例患者（平均年龄50.9±16.5岁；范围24至70岁）接受达托霉素单药治疗。根据临床改善情况、微生物清除情况和住院死亡率评估治疗结果。
13例患者（92.8%）血培养呈阳性，除1例患者外所有患者均分离出葡萄球菌（92.3%）。达托霉素单药治疗剂量为6或8mg/kg/天，平均治疗40.6±4.4天。临床治愈率为71.4%，微生物清除率为85.7%。临床恢复的平均持续时间为8.7±3.2天，微生物清除的持续时间为11.1±3.6天。6例患者出现副作用，但无一例患者需要停药。10例患者病情改善且无并发症。2例患者在治疗过程中因心力衰竭和多器官衰竭死亡，2例患者在心脏术后早期死亡。
达托霉素是治疗左侧IE的一种有效且安全的标准抗生素替代疗法。
