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Leone S, Pezone I, Pisaturo M, McCaffery E, Alfieri A, Fiore M. Pharmacotherapies for multidrug-resistant gram-positive infections: current options and beyond. Expert Opin Pharmacother 2024:1-11. [PMID: 38863433 DOI: 10.1080/14656566.2024.2367003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Infections due to multidrug-resistant organisms (MDRO) are a serious concern for public health with high morbidity and mortality. Though many antibiotics have been introduced to manage these infections, there are remaining concerns regarding the optimal management of Gram-positive MDROs. AREAS COVERED A literature search on the PubMed/Medline database was conducted. We applied no language and time limits for the search strategy. In this narrative review, we discuss the current options for managing Gram-positive MDROs as well as non-traditional antibacterial agents in development. EXPERT OPINION Despite their introduction more than 70 years ago, glycopeptides are still the cornerstone in treating Gram-positive infections: all registrative studies of new antibiotics have glycopeptides as control; these studies are designed as not inferior studies, therefore it is almost impossible to give recommendations other than the use of glycopeptides in the treatment of Gram-positive infections. The best evidence on treatments different from glycopeptides comes from post-hoc analysis and meta-analysis. Non-traditional antibacterial agents are being studied to aid in short and effective antibiotic therapies. The use of non-traditional antibacterial agents is not restricted to replacing traditional antibacterial agents with alternative therapies; instead, they should be used in combination with antibiotic therapies.
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Affiliation(s)
- Sebastiano Leone
- Division of Infectious Diseases, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Ilaria Pezone
- Department of Pediatrics, "San Giuseppe Moscati" Hospital, Aversa CE, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleni McCaffery
- Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Aniello Alfieri
- Department of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio Cardarelli, Naples, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli, Naples, Italy
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Kalkinis A, Vassilopoulos G, Rokas S, Koutserimpas C, Samonis G. Contribution of Positron Emission Tomography-Computed Tomography (PET/CT) to the Diagnosis of Endocarditis Due to an Infected Pacemaker Associated With Spondylodiscitis. Cureus 2023; 15:e43140. [PMID: 37692566 PMCID: PMC10484159 DOI: 10.7759/cureus.43140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
The incidence of cardiac device-related endocarditis (CDRIE) is increasing, and its diagnosis and treatment may occasionally be problematic. Echocardiography is important for its diagnosis, and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) may also be useful as a diagnostic procedure. A case of CDRIE due to an infected pacemaker is presented. In this case, blood cultures were repeatedly negative, and transesophageal ultrasound examination did not reveal signs of the disease. However, PET/CT revealed the infection. The causative organism was Corynebacterium spp, and this was finally identified by polymerase chain reaction of a sample of the device material. Eight weeks before the development of CDRIE symptoms, the patient had been empirically treated for spondylodiscitis caused by a non-identified organism. CDRIE and spondylodiscitis are closely associated infections. The present case of CDRIE was treated successfully with six weeks of combination antimicrobial treatment. PET/CT may contribute to CDRIE diagnosis by locating the site(s) of the infection, especially in cases that are ultrasound and culture negative.
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Affiliation(s)
| | | | - Stelios Rokas
- Department of Cardiology, Metropolitan Hospital, Athens, GRC
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - George Samonis
- Department of Oncology, Metropolitan Hospital, Athens, GRC
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Onofrei VA, Adam CA, Marcu DTM, Crisan Dabija R, Ceasovschih A, Constantin M, Grigorescu ED, Petroaie AD, Mitu F. Infective Endocarditis during Pregnancy-Keep It Safe and Simple! MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050939. [PMID: 37241171 DOI: 10.3390/medicina59050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Radu Crisan Dabija
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Elena-Daniela Grigorescu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No. 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Professor Dr. Doc. Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
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Pallotto C, Bolla C, Penpa S, Genga G, Sarda C, Svizzeretto E, Tommasi A, Stolaj E, Salvaderi A, Piceni G, Maconi A, Chichino G, Francisci D. Adherence to 2015 ESC Guidelines for the Treatment of Infective Endocarditis: A Retrospective Multicentre Study (LEIOT Study). Antibiotics (Basel) 2023; 12:antibiotics12040705. [PMID: 37107067 PMCID: PMC10135336 DOI: 10.3390/antibiotics12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cesare Bolla
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Serena Penpa
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Giovanni Genga
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cristina Sarda
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Elisabetta Svizzeretto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Tommasi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Elisa Stolaj
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Salvaderi
- Infectious Diseases Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giorgia Piceni
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
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Jones TW, Jun AH, Michal JL, Olney WJ. High-Dose Daptomycin and Clinical Applications. Ann Pharmacother 2021; 55:1363-1378. [PMID: 33535792 DOI: 10.1177/1060028021991943] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate evidence for high-dose daptomycin (doses ≥ 8 mg/kg/d). DATA SOURCES A PubMed/MEDLINE literature search was performed (January 2000 to December 2020) using the search terms daptomycin, high dose, and dosing. Review article references and society guidelines were reviewed. STUDY SELECTION AND DATA EXTRACTION Clinical trials, observational studies, retrospective studies, meta-analyses, and systematic reviews reporting on high-dose daptomycin were included. DATA SYNTHESIS Experimentally, daptomycin outperforms other antimicrobials for high inoculum and biofilm-associated infections. Clinically, high-dose daptomycin is supported as salvage and first-line therapy for endocarditis and bacteremia, primarily when caused by methicillin-resistant Staphylococcus aureus (when vancomycin minimum inhibitory concentration is >1 mg/L) and Enterococcus. High-dose daptomycin appears effective for osteomyelitis and central nervous system infections, although comparative studies are lacking. High dosing in renal replacement therapy requires considering clearance modality to achieve exposures like normal renal function. Weight-based dosing in obesity draws concern for elevated exposures, although high doses have not been evaluated kinetically in obesity. Some data show benefits of high doses in overweight populations. Burn patients clear daptomycin more rapidly, and high doses may only achieve drug exposures similar to standard doses (6 mg/kg). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review analyzes the efficacy and safety of high-dose daptomycin in serious gram-positive infections. Discussion of specific infectious etiologies and patient populations should encourage clinicians to evaluate their daptomycin dosing standards. CONCLUSIONS The efficacy of high-dose daptomycin and limited safety concerns encourage clinicians to consider high-dose daptomycin more liberally in severe gram-positive infections.
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Yozgat CY, Uzuner S, Ay Y, Temur HO, Bursal Duramaz B, Turel O, Calim M, Buyukpinarbasili N, Yozgat Y. Lifesaving Treatment of Aortic Valve Staphylococcus aureus Endocarditis: Daptomycin and Early Surgical Therapy. J Pediatr Intensive Care 2020; 10:298-302. [PMID: 34745704 DOI: 10.1055/s-0040-1713614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022] Open
Abstract
Infective endocarditis (IE) is an uncommon infection in children. The recommended treatment for native valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus infection is antistaphylococcal penicillins such as nafcillin or oxacillin. If the initial therapy fails in IE, it can lead to catastrophic results. Nowadays, daptomycin is the best alternative antimicrobial agent to treat children with severe infections, when standard antimicrobial therapy does not yield a result. Herein, in this article, we described a case of a 16-year-old boy who had aortic valve S. aureus endocarditis with septic embolization and stroke. The patient was successfully treated only with daptomycin as well as surgical therapy in the early phase of the infection.
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Affiliation(s)
| | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Yasin Ay
- Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University, Istanbul, Turkey
| | - Nur Buyukpinarbasili
- Department of Pathology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Acharya S, Anwar S, Iannuzzi M, Anugu V, Ghavami F. Isolated Pulmonary Valve Endocarditis. Cureus 2020; 12:e8650. [PMID: 32685317 PMCID: PMC7366070 DOI: 10.7759/cureus.8650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Infective endocarditis involving the right side of the heart is typically associated with IV drug abuse and chronic indwelling catheters which commonly involve the tricuspid valve. Isolated pulmonary valve endocarditis (PVE) is a rare clinical entity. We report a rare case of a young woman with a history of end-stage renal disease (ESRD) on hemodialysis through tunneled catheter presenting with persistent coagulase-negative staphylococcus (CoNS) epidermidis bacteremia despite being on appropriate treatment with IV vancomycin for two weeks. Because of the persistent bacteremia, a transesophageal echocardiogram was performed and it revealed a thickened pulmonary valve with 1.8 cm vegetation in the left posterior cusp. She was successfully treated with IV daptomycin course for a total of six weeks. The recommended management for PVE is usually medical treatment with IV antibiotics gauged according to sensitivities of the cultures. Our article highlights the fact that the decision to manage it medically versus surgically can propose a challenge as the guidelines are not very robust.
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Multifunctional Pharmaceutical Effects of the Antibiotic Daptomycin. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8609218. [PMID: 31263709 PMCID: PMC6556800 DOI: 10.1155/2019/8609218] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 02/06/2023]
Abstract
Daptomycin (DAP), a cyclic lipopeptide produced by Streptomyces roseosporus, is a novel antibiotic to clinically treat various Gram-positive pathogenic bacteria-induced infections. Although DAP has a strong broad-spectrum bactericidal effect, recently rare bacterial antibiotic resistance against DAP gradually arises. The review is to summarize the normal indications of DAP, its off-label usage against several clinical pathogen infections, the unique antibacterial mechanisms of DAP, and the combination of antibiotic therapies for highly DAP-resistant pathogens. More noticeably, rising evidences demonstrate that DAP has new potential activity of anticancer and immunomodulatory effects. So far the multifunctional pharmaceutical effects of DAP deserve to be further explored for future clinical applications.
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Crass RL, Powell KL, Huang AM. Daptomycin for the treatment of Staphylococcus aureus infections complicated by septic pulmonary emboli. Diagn Microbiol Infect Dis 2019; 93:131-135. [DOI: 10.1016/j.diagmicrobio.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/18/2018] [Accepted: 09/06/2018] [Indexed: 01/09/2023]
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Xu P, Zeng H, Zhou M, Ouyang J, Chen B, Zhang Q. Successful management of a complicated clinical crisis: A patient with left-sided endocarditis and secondary hemophagocytic lymphohistiocytosis: a rare case report and literature review. Medicine (Baltimore) 2017; 96:e9451. [PMID: 29390580 PMCID: PMC5758282 DOI: 10.1097/md.0000000000009451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Hemophagocytic lymphohistiocytosis (HLH) secondary to methicillin-resistant Staphylococcus epidermidis (MRSE)-related left-sided infectious endocarditis had never been reported before. In the last decade, daptomycin, a novel lipopeptide antibiotic, showed its excellent role in anti-Gram-positive bacteria, including soft tissue infection, bloodstream and deep tissueinfection. PATIENT CONCERNS An Asian women under sever condition due to the cooccurrence of HLH and MRSE-related endocarditis while also be allergic to vancomycin. The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. DIAGNOSES IE was made on March 27according to the modified Duke criteria. HLH was diagnosed too. INTERVENTIONS The patient was cured by high-dose daptomycin monotheraphy, HLH-2004 protocol and cardiothoracic surgery to remove the valve at last, and was obviously benefit from the endeavor of a multidisciplinary team (MDT) strategy. OUTCOMES The patient was healthy andstable when we published this case. LESSONS This case proves high-dose daptomycin monotheraphy could be used as an effective alternative regimen for vancomycin in treating MRSE-related left-sided endocarditis and highlight the importance of early diagnosis and appropriate management for HLH. Furthermore, our work suggests an MDT model as a practical strategy in managing similar clinical situation.
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Guleri A, Utili R, Dohmen P, Hamed K. Effectiveness and safety of daptomycin in patients with infective endocarditis undergoing heart valve replacement: a subgroup analysis from real-world data. Ther Adv Infect Dis 2017. [PMID: 28634535 DOI: 10.1177/2049936117692297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND European Cubicin® Outcomes Registry and Experience (EU-CORE) was a retrospective, non-interventional, multicenter registry that collected real-world clinical outcomes following daptomycin use for the treatment of Gram-positive infections. EU-CORE data from patients with infective endocarditis (IE) who underwent heart valve replacement were analysed. METHODS Clinical outcomes were assessed as success (cured or improved), failure, or non-evaluable. Adverse events (AEs) were recorded for up to 30 days after daptomycin treatment. RESULTS Of 610 patients with IE, 198 [32.5%; left-sided IE (LIE), 166 (83.8%); right-sided IE (RIE), 21 (10.6%); both LIE and RIE, 11 (5.6%)] underwent heart valve replacement. Other than cardiovascular disease, renal disease (18.2%), sepsis (16.2%), and diabetes mellitus (15.2%) were the most significant underlying diseases. Major pathogens in patients with positive culture results (68.0%) were Staphylococcus aureus [36.8%; methicillin-resistant S. aureus (MRSA), 12.8%] and coagulase-negative staphylococci (CoNS; 31.6%). Daptomycin treatment [median duration (range), 21 days (1-112)] resulted in high clinical success in patients with S. aureus (88.4%; MRSA, 80.0%) and CoNS (81.1%) infections, with an overall success rate of 83.3%. Clinical success rate was high (90.0%) in patients who received daptomycin dose >6 mg/kg/day. Overall clinical success rate in patients followed for up to 2 years was 90.7%. AEs and serious AEs possibly related to daptomycin were reported in 6 (3.0%) and 4 (2.0%) patients, respectively. CONCLUSIONS Daptomycin treatment was effective and well tolerated with a sustained response in patients with IE who underwent heart valve surgery. A trend towards better clinical outcomes was observed with higher daptomycin doses.
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Affiliation(s)
- Achyut Guleri
- Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Riccardo Utili
- Second University of Naples and Monaldi Hospital, Napoli, Italy
| | - Pascal Dohmen
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Yamada T, Kato R, Oda K, Tanaka H, Suzuki K, Ijiri Y, Ikemoto T, Nishihara M, Hayashi T, Tanaka K, Tamai H, Ukimura A, Katsumata T. False Prolongation of Prothrombin Time in the Presence of a High Blood Concentration of Daptomycin. Basic Clin Pharmacol Toxicol 2016; 119:353-9. [PMID: 27060578 DOI: 10.1111/bcpt.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/01/2016] [Indexed: 12/13/2022]
Abstract
Prothrombin time (PT) can reportedly be falsely prolonged by the antimicrobial drug daptomycin (DAP), and concomitant use of phosphatidylglycerol (PG). Although high doses of DAP (>6 mg/kg/day) are recommended for severe infection and result in a high blood concentration, the extent to which high blood concentrations of DAP interfere with PT, in the presence or absence of PG, has yet to be determined when using the HemosIL RecombiPlasTin 2G (Werfen Japan, Tokyo, Japan). We examined the effects of high doses of DAP on PT using this reagent. DAP (0-500 mg/L) was added to normal plasma and plasma with an already prolonged PT in the presence or absence of liposomal amphotericin B (L-AMB, 5-50 mg/L) or COATSOME EL-01 empty cationic liposomes (CS, 25-250 mg/L). Furthermore, we undertook a Monte Carlo simulation to calculate the probability of achieving DAP concentrations >100, >200 and >500 mg/L 0-48 hr after administering 6-12 mg/kg of DAP. Apparent PT increased with increasing DAP concentration, but neither L-AMB nor CS appeared to further elevate PT when co-administered with DAP. The probability of achieving DAP concentrations >100 and >200 mg/L increased with DAP dose. Higher doses of DAP than the approved dose caused false prolongation of PT. PT should be monitored carefully in patients taking high doses of DAP; ideally, PT should be measured at the trough blood concentration of DAP. Concomitant use of L-AMB and CS did not generally further elevate PT when co-administered with DAP.
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Affiliation(s)
- Tomoyuki Yamada
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan. .,Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan.
| | - Ryuji Kato
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Hidema Tanaka
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Kaoru Suzuki
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Yoshio Ijiri
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Toshiyuki Ikemoto
- Department of Clinical Laboratory, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Tetsuya Hayashi
- Laboratory of Cardiovascular Pharmacology and Toxicology, Osaka University of Pharmaceutical Sciences, Osaka, Japan.,Department of Internal Medicine III, Osaka Medical College, Osaka, Japan
| | | | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
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Gisler V, Müller S, Müller L, Jörg-Walther L, Sendi P. Acute Angioedema Triggered by Daptomycin. Infect Dis Ther 2016; 5:201-5. [PMID: 27228997 PMCID: PMC4929090 DOI: 10.1007/s40121-016-0111-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Daptomycin is a cyclic lipopeptide antibiotic, frequently administered for Staphylococcus aureus bloodstream infections. Numerous studies have shown that daptomycin is relatively safe and well tolerated. Serious adverse events possibly related to this antimicrobial compound are rare. We report a case of acute angioedema triggered by daptomycin. CASE REPORT A 60-year-old woman with S. aureus bacteremia without identified source was treated intravenously with high-dose beta-lactams at our institution. Because S. aureus bacteremia persisted on day 6, and in parallel, acute kidney injury developed, antimicrobial treatment was switched to a combination therapy with daptomycin and ceftriaxone. Shortly after completion of the first daptomycin administration, the patient developed lip and tongue swelling and dyspnea. Acute angioedema was clinically evident. Antibiotic therapy was switched to vancomycin, and the further clinical course was favorable. An intradermal test showed a significant wheal diameter for daptomycin, but negative results for ceftriaxone. CONCLUSION The association with daptomycin in this case is either probable or certain. Clinicians should be aware that daptomycin can cause immediate-type hypersensitivity reactions, including acute angioedema, even upon first administration.
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Affiliation(s)
- Valentin Gisler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Müller
- Department of Clinical Pharmacology and Regional Pharmacovigilance Center, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lionel Müller
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Jörg-Walther
- Department of Rheumatology, Immunology and Allergology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Parham Sendi
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
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Gonzalez-Ruiz A, Seaton RA, Hamed K. Daptomycin: an evidence-based review of its role in the treatment of Gram-positive infections. Infect Drug Resist 2016; 9:47-58. [PMID: 27143941 PMCID: PMC4846043 DOI: 10.2147/idr.s99046] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Infections caused by Gram-positive pathogens remain a major public health burden and are associated with high morbidity and mortality. Increasing rates of infection with Gram-positive bacteria and the emergence of resistance to commonly used antibiotics have led to the need for novel antibiotics. Daptomycin, a cyclic lipopeptide with rapid bactericidal activity against a wide range of Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, has been shown to be effective and has a good safety profile for the approved indications of complicated skin and soft tissue infections (4 mg/kg/day), right-sided infective endocarditis caused by S. aureus, and bacteremia associated with complicated skin and soft tissue infections or right-sided infective endocarditis (6 mg/kg/day). Based on its pharmacokinetic profile and concentration-dependent bactericidal activity, high-dose (>6 mg/kg/day) daptomycin is considered an important treatment option in the management of various difficult-to-treat Gram-positive infections. Although daptomycin resistance has been documented, it remains uncommon despite the increasing use of daptomycin. To enhance activity and to minimize resistance, daptomycin in combination with other antibiotics has also been explored and found to be beneficial in certain severe infections. The availability of daptomycin via a 2-minute intravenous bolus facilitates its outpatient administration, providing an opportunity to reduce risk of health care-associated infections, improve patient satisfaction, and minimize health care costs. Daptomycin, not currently approved for use in the pediatric population, has been shown to be widely used for treating Gram-positive infections in children.
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Affiliation(s)
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Seaton RA, Gonzalez-Ruiz A, Cleveland KO, Couch KA, Pathan R, Hamed K. Real-world daptomycin use across wide geographical regions: results from a pooled analysis of CORE and EU-CORE. Ann Clin Microbiol Antimicrob 2016; 15:18. [PMID: 26976128 PMCID: PMC4791778 DOI: 10.1186/s12941-016-0130-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/29/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pooled data from two large registries, Cubicin® Outcomes Registry and Experience (CORE; USA) and European Cubicin® Outcomes Registry and Experience (EU-CORE; Europe, Latin America, and Asia), were analyzed to determine the characteristics and clinical outcomes of daptomycin therapy in patients with Gram-positive infections across wide geographical regions. Methods Patients receiving at least one dose of daptomycin between 2004 and 2012 for the treatment of Gram-positive infections were included. Clinical success was defined as an outcome of ‘cured’ or ‘improved’. Post-treatment follow-up data were collected for a subset of patients (CORE: osteomyelitis and orthopedic foreign body device infection; EU-CORE: endocarditis, intracardiac/intravascular device infection, osteomyelitis, and orthopedic device infection). Safety was assessed for up to 30 days after daptomycin treatment. Results In 11,557 patients (CORE, 5482; EU-CORE, 6075) treated with daptomycin (median age, 62 [range, 1–103] years), the most frequent underlying conditions were cardiovascular disease (54.7 %) and diabetes mellitus (28.0 %). The most commonly treated primary infections were complicated skin and soft tissue infection (cSSTI; 31.2 %) and bacteremia (21.8 %). The overall clinical success rate was 77.2 % (uncomplicated SSTI, 88.3 %; cSSTI, 81.0 %; osteomyelitis, 77.7 %; foreign body/prosthetic infection (FBPI), 75.9 %; endocarditis, 75.4 %; and bacteremia, 69.5 %). The clinical success rate was 79.1 % in patients with Staphylococcus aureus infections (MRSA, 78.1 %). An increasing trend of high-dose daptomycin (>6 mg/kg/day) prescribing pattern was observed over time. Clinical success rates were higher with high-dose daptomycin treatment for endocarditis and FBPI. Adverse events (AEs) and serious AEs possibly related to daptomycin therapy were reported in 628 (5.4 %) and 133 (1.2 %) patients, respectively. Conclusions The real-world data showed that daptomycin was effective and safe in the treatment of various Gram-positive infections, including those caused by resistant pathogens, across wide geographical regions.
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Affiliation(s)
| | | | | | - Kimberly A Couch
- Infectious Diseases Pharmacy Associates, Inc., Stevensville, MD, USA
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
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