Wu Cuifang, Li Zuojun, Wang Chunjiang, Deng Zhenzhen
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Med Clin (Barc). 2023 Jan 5;160(1):17-22. doi: 10.1016/j.medcli.2022.03.017. Epub 2022 Jul 12.
The association between daptomycin exposure and eosinophilic pneumonia (EP) is mainly based on case reports. The purpose of this study was to evaluate the clinical characteristics and provide more evidence for better identify and management of daptomycin-induced eosinophilic pneumonia in clinical practice.
Literature from 1991 to October 31, 2021 on EP induced by daptomycin were collected for retrospective analysis.
A total of 47 patients (40 male and 7 female) from 35 studies were included. The median age was 67 years (range 28-89), and 78.7% of patients were ≥60 years. Daptomycin was mainly used in patients undergoing osteoarticular infections (63.8%). Typical initial symptoms were fever (91.5%), cough (55.3%) and dyspnea (59.6%). The median onset time of symptom was 3 weeks. EP recurred in 14.9% of patients after the re-administration of daptomycin, and 57.1% of EP recurred within 24h. Most cases were accompanied by marked accumulation of eosinophils in peripheral (41 cases) and/or bronchoalveolar lavage fluid (27 cases). The main radiological features were pulmonary infiltration, ground glass opacity or consolidation in CT/CXR. All patients had symptom resolution after discontinuation of daptomycin except for one patient died due to the progression of the primary disease, the median time to symptoms relief was 3 days. Corticosteroids have been shown to help symptoms relief in some cases (59.6%).
Daptomycin-induced eosinophilic pneumonia is a rare and serious complication. Physicians should consider eosinophilic pneumonia as a differential diagnosis when receiving daptomycin therapy, particularly in elderly male patients.
达托霉素暴露与嗜酸性粒细胞性肺炎（EP）之间的关联主要基于病例报告。本研究的目的是评估其临床特征，并为在临床实践中更好地识别和管理达托霉素诱导的嗜酸性粒细胞性肺炎提供更多证据。
收集1991年至2021年10月31日期间关于达托霉素诱导的EP的文献进行回顾性分析。
共纳入35项研究中的47例患者（男性40例，女性7例）。中位年龄为67岁（范围28 - 89岁），78.7%的患者年龄≥60岁。达托霉素主要用于骨关节炎感染患者（63.8%）。典型的初始症状为发热（91.5%）、咳嗽（55.3%）和呼吸困难（59.6%）。症状的中位发作时间为3周。14.9%的患者在再次使用达托霉素后EP复发，57.1%的EP在24小时内复发。大多数病例外周血（41例）和/或支气管肺泡灌洗液（27例）中伴有明显的嗜酸性粒细胞增多。主要的影像学特征为CT/CXR上的肺部浸润、磨玻璃影或实变。除1例因原发性疾病进展死亡外，所有患者在停用达托霉素后症状均缓解，症状缓解的中位时间为3天。在某些情况下，皮质类固醇已被证明有助于缓解症状（59.6%）。
达托霉素诱导的嗜酸性粒细胞性肺炎是一种罕见且严重的并发症。医生在接受达托霉素治疗时应将嗜酸性粒细胞性肺炎作为鉴别诊断，尤其是在老年男性患者中。
