Retrospective case-control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy
Retrospective case-control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy
复制标题
达托霉素或糖肽治疗葡萄球菌感染患者的回顾性病例对照分析
DOI：
10.1016/j.ijantimicag.2011.09.011
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发表时间：
2012-01-01
影响因子：
10.8
通讯作者：
Venditti, Mario
中科院分区：
文献类型：
--
作者：
Falcone, Marco;Russo, Alessandro;Venditti, Mario
几年来，糖肽类一直被认为是严重耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MR-CoNS）感染的首选抗菌剂。达托霉素是治疗这些感染的新选择，包括那些对糖肽类药物敏感性降低的感染。本研究的目的是比较糖肽类药物和达托霉素治疗MRSA或MR-CoNS引起的感染。回顾性分析了106例血流感染（菌血症或感染性心内膜炎）或皮肤和软组织感染（SSTI）患者的数据，其中43例接受达托霉素治疗（DAP组），63例接受万古霉素或替考拉宁治疗（GLYCO组）。两个对照组中的患者在年龄、风险因素和临床严重程度方面具有同质性。两组患者的病原学均以MRSA为主，其次为各种MR-CoNS，达托霉素在中心静脉导管相关菌血症或起搏器相关感染患者中的使用频率更高。与DAP组相比，GLYCO组的SSTI患者的抗生素治疗平均持续时间更长（18.2天vs. 14.6天; P = 0.009），平均住院时间更长（28.2天vs. 19.6天; P = 0.01）。在接受糖肽类药物治疗的血流感染患者中，也观察到抗生素治疗的平均持续时间更长（25.6天vs. 18天; P = 0.004）。总之，达托霉素的良好临床疗效与临床综合征的更快消退和住院时间缩短相关。后一方面可能具有重要的药物经济学意义，促进达托霉素在临床环境中的使用。(C)2011年Elsevier B. V.和国际化疗学会。All rights reserved.
Glycopeptides have been considered the antimicrobials of choice for serious meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) infections for several years. Daptomycin is a new option for the treatment of these infections, including those exhibiting reduced susceptibility to glycopeptides. The aim of this study was to compare glycopeptides and daptomycin for the treatment of infections caused by MRSA or MR-CoNS. Data for 106 patients with bloodstream infections (bacteraemia or infective endocarditis) or skin and soft-tissue infections (SSTIs) were retrospectively reviewed, of which 43 were treated with daptomycin (DAP group) and 63 were treated with vancomycin or teicoplanin (GLYCO group). Patients included in the two comparison groups were homogeneous in terms of age, risk factors and clinical severity. Aetiology was mainly represented by MRSA in both groups, followed by various species of MR-CoNS. Daptomycin was used more frequently in patients with central venous catheter-associated bacteraemia or pacemaker-associated infection. Patients with SSTIs included in the GLYCO group had a longer mean duration of antibiotic therapy (18.2 days vs. 14.6 days; P = 0.009) and a longer mean length of hospital stay (28.2 days vs. 19.6 days; P = 0.01) compared with those included in the DAP group. A longer mean duration of antibiotic therapy was also observed in patients with bloodstream infections receiving glycopeptide therapy (25.6 days vs. 18 days; P = 0.004). In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting. (C) 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.