1. Should High-dose Daptomycin be an Alternative Treatment Regimen for Enterococcal Endocarditis?
- Author
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Filippo Givone, Martina Ingani, Matteo Bassetti, Alessandro Russo, Elena Graziano, and Maddalena Peghin
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Combination therapy ,030106 microbiology ,Enterococcal infective endocarditis ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,Daptomycin ,Internal medicine ,medicine ,Enterococcus spp ,lcsh:RC109-216 ,030212 general & internal medicine ,Prospective cohort study ,business.industry ,Mortality rate ,Brief Report ,High-dose daptomycin ,medicine.disease ,Alternative treatment ,Regimen ,Infectious Diseases ,Infective endocarditis ,business ,medicine.drug - Abstract
Introduction Previous series on the use of daptomycin in enterococcal infective endocarditis (EIE) have shown various outcomes, including higher mortality rates. We analyzed the effectiveness of high-dose daptomycin for the treatment of EIE. Methods We performed a prospective study from 2010 to 2018 in a referral center in patients with native (NVE) and prosthetic valve endocarditis (PVE) due to Enterococcus spp. The standard high-dose daptomycin at our institution is 10–12 mg/kg/day (CLCr > 30 ml/min). We compared the efficacy of a daptomycin-based regimen (DBR) versus daptomycin-sparing regimen (DSR) and daptomycin monotherapy versus combination therapy. Primary endpoints of the study were evaluation of risk factors associated with 30-day mortality and failure at end of therapy. Results We collected 43 EIE cases; 29 were NVE (67.4%). Overall, 16 (37.2%) were treated with DBR, mainly with combination regimens (11, 68.7%), in the majority of cases in association with ß-lactam (7, 43.7%). The mean administered dose of daptomycin was 10.125 mg/kg/day (range 8–12 mg/kg/day). Overall, patients treated with DBR compared with patients treated with DSR had no higher mortality rates and/or failure at end of therapy (6.2% vs. 22. 2%; P 0.41 and MICs 0.25–2 mg/l, 6.2% vs. 3.7%; P 1.0). In the sub-group of patients with NVE and PVE treated with DBR and DSR, no difference was found regarding the primary endpoints on the single or combined use of daptomycin. Conclusion Our findings suggest that high-dose daptomycin might be used as an alternative treatment regimen in EIE.
- Published
- 2019