https://scholars.lib.ntu.edu.tw/handle/123456789/535161
標題: | Safety and efficacy of high-dose daptomycin as salvage therapy for severe gram-positive bacterial sepsis in hospitalized adult patients | 作者: | Lai C.-C. WANG-HUEI SHENG JANN-TAY WANG ARISTINE CHENG YU-CHUNG CHUANG YEE-CHUN CHEN SHAN-CHWEN CHANG |
公開日期: | 2013 | 卷: | 13 | 期: | 1 | 起(迄)頁: | 66 | 來源出版物: | BMC Infectious Diseases | 摘要: | 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. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84873176925&doi=10.1186%2f1471-2334-13-66&partnerID=40&md5=38a214e274223928a399aed1d62309b4 https://scholars.lib.ntu.edu.tw/handle/123456789/535161 |
ISSN: | 1471-2334 | DOI: | 10.1186/1471-2334-13-66 | SDG/關鍵字: | 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 |
顯示於: | 醫學系 |
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