Cardiovascular implantable electronic device endocarditis treated with daptomycin with or without transvenous removal

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• 作者：Carlo Tascini ; MD^a ; Maria Grazia Bongiorni ; MD^b ; Andrea Di Cori ; MD^b ; Antonello Di Paolo ; MD^c ; Marina Polidori ; MD^a ; Enrico Tagliaferri ; MD^a ; ^{tagliaferrienrico@alice.it} ; Serena Fondelli ; MD^a ; Ezio Soldati ; MD^b ; Ilaria Ciullo ; BS^a ; Alessandro Leonildi ; BS^a ; Romano Danesi ; PhD^c ; Giovanni Coluccia ; MD^b ; Francesco Menichetti ; MD^a
• 关键词：Daptomycin ; Cardiovascular implantable electronic device ; Endocarditis ; Transvenous removal
• 刊名：Heart Lung: The Journal of Acute and Critical Care
• 出版年：2012
• 出版时间：November-December, 2012
• 年：2012
• 卷：41
• 期：6
• 页码：e24-e30
• 全文大小：202 K

文摘

Background and Methods

Nine patients with cardiovascular implantable electronic device (CIED) endocarditis were treated with daptomycin after the failure of previous treatment. The blood and CIED lead cultures of 1 patient were negative. In the other 8 patients, we observed 6 monomicrobic infections and 2?polymicrobic infections. Overall, 10 strains were isolated in these patients: 4?methicillin-sensitive Staphylococcus aureus, 2 methicillin-sensitive Staphylococcus epidermidis, 1 methicillin-resistant Staphylococcus aureus, 1 methicillin-resistant Staphylococcus epidermidis, 1 methicillin-sensitive Staphylococcus hominis, and 1 Propionibacterium acnes. The CIED was removed transvenously in 7 patients. Two patients were too sick for the removal of their CIED, and were cured with 6 mg/kg of daptomycin for 60 and 110 days, respectively, without adverse events.

Results

One patient died 4 days after the removal of his CIED because of a complicated abdominal aortic aneurysm. The other 8 patients were cured, with a mean follow-up of 17 ¡À 8 months. The removed leads were negative, after daptomycin therapy, in 4 cases out of 7. The mean ratio between peak daptomycin concentration and minimal inhibitory concentration (MIC) of the causative strains was 38.3 ¡À 18.5. For patients whose data were available, the ratio between peak daptomycin concentration and minimal bactericidal concentration (MBC) was 13.2 ¡À 3.2.

Conclusion

Daptomycin monotherapy may be a useful therapeutic tool in difficult-to-treat CIED endocarditis, resulting in a high rate of cures and sterilized leads removed. The ratio between peak daptomycin concentration and MIC or MBC may be useful as predictive tool for treatment success.