Influence of daptomycin doses on the outcomes of VRE bloodstream infection treated with high-dose daptomycin.
J Antimicrob Chemother
; 77(8): 2278-2287, 2022 07 28.
Article
em En
| MEDLINE
| ID: mdl-35639586
ABSTRACT
OBJECTIVES:
The CLSI recommended high-dose daptomycin (8-12â mg/kg) for treating Enterococcus faecium bloodstream infections (BSI). The current study was designed to determine the safety and efficacy of increasing the daptomycin dose for VRE BSI patients receiving ≥8â mg/kg.METHODS:
We conducted a multicentre prospective observational study of patients who received a ≥8â mg/kg dose of daptomycin for treatment of VRE BSI. The primary outcome was 28â day mortality.RESULTS:
A total of 661 patients were included. The 28â day mortality rate was 45.1%. The survivors received higher doses of daptomycin than non-survivors (10.1 versus 9.8â mg/kg; Pâ<â0.001). An increase in the daptomycin dose independently predicted lower mortality [adjusted OR (aOR)â=â0.85; 95% CIâ=â0.73-0.99; Pâ=â0.03]. Eighty-six survivors (23.7%) and 43 non-survivors (14.4%) received a ≥11â mg/kg dose of daptomycin (Pâ=â0.003). The 8 to <11 and ≥11â mg/kg doses of daptomycin differed in the 28â day mortality in the higher MIC group (≥2â mg/L) (49.4% versus 33.3%; Pâ=â0.004), but not in the lower MIC group (≤1â mg/L) (29.3% versus 29.4%; Pâ=â0.99). A dose of ≥11â mg/kg was associated with a higher (3.9%) rate of highly elevated creatine kinase (>2000â U/L) compared with 1.1% with 8 to <11â mg/kg (Pâ=â0.04).CONCLUSIONS:
The efficacy of daptomycin is dose dependent. A high daptomycin dose, especially at ≥11â mg/kg, improved survival in patients with VRE BSI, but was associated with highly elevated creatine kinase. We recommend a ≥11â mg/kg dose of daptomycin be considered for treatment of VRE BSI, particularly for isolates with higher MICs.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Bactérias Gram-Positivas
/
Enterococcus faecium
/
Bacteriemia
/
Daptomicina
/
Sepse
/
Enterococos Resistentes à Vancomicina
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Taiwan