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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Carugati, M; Bayer, AS; Miró, JM; Park, LP; Guimarães, AC; Skoutelis, A; Fortes, CQ; Durante-Mangoni, E; Hannan, MM; Nacinovich, F; Fernández-Hidalgo, N; Grossi, P; Tan, R-S; Holland, T; Fowler, VG; Corey, RG; Chu, VH; International Collaboration on Endocarditis,

Published Date

  • December 2013

Published In

Volume / Issue

  • 57 / 12

Start / End Page

  • 6213 - 6222

PubMed ID

  • 24080644

Pubmed Central ID

  • 24080644

Electronic International Standard Serial Number (EISSN)

  • 1098-6596

Digital Object Identifier (DOI)

  • 10.1128/AAC.01563-13

Language

  • eng

Conference Location

  • United States