Safety and efficacy of high-dose daptomycin as salvage therapy for severe gram-positive bacterial sepsis in hospitalized adult patients
Journal
BMC Infectious Diseases
Journal Volume
13
Journal Issue
1
Pages
66
Date Issued
2013
Author(s)
Abstract
Background: Increasing the dosage of daptomycin may be advantageous in severe infection by enhancing bactericidal activity and pharmacodynamics. However, clinical data on using daptomycin at doses above 6 mg/kg in Asian population are limited.Methods: A retrospective observational cohort study of all hospitalized adult patients treated with daptomycin (> 6 mg/kg) for at least 72 hours was performed in Taiwan.Results: A total of 67 patients (40 males) with a median age of 57 years received a median dose of 7.61 mg/kg (range, 6.03-11.53 mg/kg) of daptomycin for a median duration of 14 days (range, 3-53 days). Forty-one patients (61.2%) were in intensive care units (ICU). Sites of infections included complicated skin and soft tissue infections (n = 16), catheter-related bacteremia (n = 16), endocarditis (n = 11), primary bacteremia (n = 10), osteomyelitis and septic arthritis (n = 9), and miscellaneous (n = 5). The median Pitt bacteremia score among the 54 (80.6%) patients with bacteremia was 4. The most common pathogen was methicillin-resistant Staphylococcus aureus (n = 38). Fifty-nine patients (88.1%) were treated with daptomycin after glycopepetide use. Overall, 52 (77.6%) patients achieved clinical success. The all-cause mortality rate at 28 day was 35.8%. In multivariate analysis, the significant predictors of in-hospital mortality in 54 bacteremic patients were malignancies (P = 0.01) and ICU stay (P = 0.02). Adverse effects of daptomycin were generally well-tolerated, leading to discontinuation in 3 patients. Daptomycin-related creatine phosphokinase (CPK) elevations were observed in 4 patients, and all received doses > 8 mg/kg.Conclusions: Treatment with high dose daptomycin as salvage therapy was generally effective and safe in Taiwan. CPK level elevations were more frequent in patients with dose > 8 mg/kg. ? 2013 Lai et al.; licensee BioMed Central Ltd.
SDGs
Other Subjects
alanine aminotransferase; aspartate aminotransferase; creatine kinase; daptomycin; hydroxymethylglutaryl coenzyme A reductase inhibitor; linezolid; polypeptide antibiotic agent; teicoplanin; vancomycin; adult; alanine aminotransferase blood level; article; aspartate aminotransferase blood level; bacteremia; bacterial arthritis; bone infection; bone marrow suppression; catheter infection; coagulase negative Staphylococcus; cohort analysis; creatine kinase blood level; cytopenia; disease severity; drug efficacy; drug megadose; drug safety; drug tolerability; drug withdrawal; endocarditis; female; gram positive sepsis; hospital patient; human; infectious arthritis; intensive care unit; kidney dysfunction; length of stay; Loeffler pneumonia; major clinical study; male; malignant neoplastic disease; methicillin resistant Staphylococcus aureus; minimum inhibitory concentration; mortality; myopathy; observational study; osteomyelitis; outcome assessment; Pitt bacteremia score; retrospective study; salvage therapy; scoring system; sepsis; side effect; skin infection; soft tissue infection; Taiwan; treatment duration; unspecified side effect; vancomycin resistant Enterococcus; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Daptomycin; Female; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Inpatients; Male; Middle Aged; Retrospective Studies; Salvage Therapy; Sepsis; Treatment Outcome; Young Adult
Type
journal article