High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis.

Abstract

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 < 0.01). Regimens with higher daptomycin doses were not associated with increased incidence of AEs. In conclusion, higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens.

• Authors: Manuela Carugati, Arnold S Bayer, Josè M Miró, Lawrence P Park, Armenio C Guimarães, Athanasios Skoutelis, Claudio Q Fortes, Emanuele Durante-Mangoni, Margaret M Hannan, Francisco Nacinovich, Nuria Fernández-Hidalgo, Paolo Grossi, Ru-San Tan, Thomas Holland, Vance G Fowler Jr, Ralph G Corey, Vivian H Chu, International Collaboration on Endocarditis
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 57 Issue 12 Pg. 6213-22 (Dec 2013) ISSN: 1098-6596 [Electronic] United States
• PMID: 24080644 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Daptomycin

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Daptomycin (therapeutic use)
• Endocarditis, Bacterial (drug therapy)
• Enterococcus faecalis (physiology)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Staphylococcus aureus (physiology)