High-Dose Daptomycin Therapy for Left-Sided Infective Endocarditis: a Prospective Study from the International Collaboration on Endocarditis
High-Dose Daptomycin Therapy for Left-Sided Infective Endocarditis: a Prospective Study from the International Collaboration on Endocarditis
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DOI：
10.1128/aac.01563-13
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发表时间：
2013-12-01
影响因子：
4.9
通讯作者：
Chu, Vivian H.
中科院分区：
文献类型：
--
作者：
Carugati, Manuela;Bayer, Arnold S.;Chu, Vivian H.
达托霉素在革兰氏阳性左侧感染性心内膜炎(IE)中的使用显著增加。本研究的目的是评估大剂量达托霉素对革兰氏阳性病原菌所致左侧IE预后的影响。这是一项前瞻性队列研究，基于2008至2010年间国际心内膜炎协作(ICE)-Plus数据库和ICE-达托霉素亚研究数据库中的1112例病例。在金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌所致的左侧IE患者中，我们比较了达托霉素(队列A)和标准护理(SOC)抗生素(队列B)治疗的患者。主要结果是住院死亡率。还评估了可归因于达托霉素的菌血症清除时间、6个月死亡率和不良事件(AEs)。A组和B组分别有29名和149名患者。基线合并症在两组患者中没有不同，除了服用达托霉素的患者中糖尿病患病率和既往IE发作显著更高。达托霉素的中位剂量为9.2 mg/kg体重/天。接受达托霉素治疗的患者中，有三分之二的患者之前的抗生素方案失败。两组患者住院期间和6个月内的死亡率相似。A组的耐甲氧西林金黄色葡萄球菌(MRSA)菌血症清除时间的中位数为1.0天，与SOC组相比，其菌血症清除速度明显快于SOC(1.0天比5.0天；P
The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This was a prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (cohort A) to those treated with standard-of-care (SOC) antibiotics (cohort B). The primary outcome was in-hospital mortality. Time to clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed. There were 29 and 149 patients included in cohort A and cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg of body weight/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In cohort A, median time to clearance of methicillin-resistant S. aureus (MRSA) bacteremia was 1.0 day, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance compared to SOC (1.0 versus 5.0 days; P