Daptomycin Therapy for Vancomycin-Resistant Enterococcal Bacteremia: A Retrospective Case Series of 30 Patients
Daptomycin Therapy for Vancomycin-Resistant Enterococcal Bacteremia: A Retrospective Case Series of 30 Patients
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DOI：
10.1592/phco.29.7.792
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发表时间：
2009-07-01
期刊：
影响因子：
4.1
通讯作者：
MacDougall, Conan
中科院分区：
文献类型：
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作者：
Gallagher, Jason C.;Perez, Mirza E.;MacDougall, Conan
研究目的。确定达托霉素治疗万古霉素耐药肠球菌（VRE）引起的菌血症的临床和微生物学结局。回顾性病历审查。设置。学术三级保健医院。病人。2004年1月至2007年7月期间，30例接受达托霉素治疗VRE菌血症的患者（中位年龄59岁，范围19-79岁，50%为男性）。如果患者接受了达托霉素治疗，并且在开始使用达托霉素时血培养VRE阳性，则纳入研究。主要终点是微生物学治愈，定义为治疗结束时VRE血培养呈阴性。次要结局是临床结局、不良事件和肌酸激酶水平升高的发生。临床结局被判定为阳性、阴性或不确定。中位急性生理学和慢性健康评估（APACHE）11评分为17（范围7-34），20例患者（67%）在重症监护室。患者接受达托霉素治疗的中位时间为13天（范围1-42天），中位给药剂量为6 mg/kg（范围3.7-8 mg/kg）。24例患者（80%）实现了微生物学治愈，17例患者（59% [1例患者临床结局不确定，被排除在本分析之外]）获得了临床成功。所有具有阳性临床结局的患者均获得微生物学治愈，6例死亡患者获得微生物学治愈，所有微生物学失败的患者均死亡。在多变量logistic回归分析中，较高的APACHE 11评分与较低的微生物学成功机会相关（校正比值比[AOR] 0.73，95%置信区间[CI] 0.56-0.95）。较低的APACHE 11评分（AOR 0.86，95% CI 0.74-1.0）和达托霉素剂量≥ 6 mg/kg（AOR 7.29，95% CI 1.02-52.0）与临床成功相关。可能归因于达托霉素的药物不良事件并不常见。3例患者出现发热，可能与达托霉素有关，2例患者出现肌酸激酶轻度升高。我们的经验表明，达托霉素可能是治疗VRE菌血症的一种可接受的选择;然而，在将这种抗菌药物常规用于该适应症之前，应进行更大规模的研究。
Study Objective. To determine clinical and microbiologic outcomes of daptomycin for the treatment of bacteremia caused by vancomycin-resistant enterococci (VRE).Design. Retrospective medical record review.Setting. Academic tertiary care hospital.Patients. Thirty patients (median age 59 yrs, range 19-79 yrs, 50% male) who received daptomycin for the treatment of VRE bacteremia between January 2004 and July 2007.Measurements and Main Results. Patients were included if they received daptomycin and had a blood culture positive for VRE at the time daptomycin was started. The primary end point was microbiologic cure, defined as negative blood cultures for VRE at the end of therapy Secondary outcomes were clinical outcomes, adverse events, and occurrence of elevated creatine kinase levels. Clinical outcomes were judged as positive, negative, or indeterminate. The median Acute Physiology and Chronic Health Evaluation (APACHE) 11 score was 17 (range 7-34), and 20 patients (67%) were in the intensive care unit. Patients received daptomycin for a median of 13 days (range 1-42 days), and the median dose administered was 6 mg/kg (range 3.7-8 mg/kg). Microbiologic cure was achieved in 24 patients (80%), and clinical success occurred in 17 patients (59% [one patient had an indeterminate clinical outcome and was excluded from this analysis]). All patients with a positive clinical outcome had microbiologic cure, six patients who died had microbiologic cure, and all patients with microbiologic failure died. On multivariable logistic regression, higher APACHE 11 score was associated with a lower chance of microbiologic success (adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.56-0.95). Lower APACHE 11 score (AOR 0.86, 95% CI 0.74-1.0) and daptomycin dose of 6 mg/kg or more (AOR 7.29, 95% CI 1.02-52.0) were associated with clinical success. Adverse drug events possibly attributable to daptomycin were uncommon. Three patients had fever possibly related to daptomycin, and two patients had mild elevations of creatine kinase level.Conclusion. Our experience suggests that daptomycin may be an acceptable option for VRE bacteremia; however, larger studies should be performed before this antimicrobial is routinely used for this indication.