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2015 ; 4
(3
): 259-71
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Real-World Treatment of Enterococcal Infections with Daptomycin: Insights from a
Large European Registry (EU-CORE)
#MMPMID26168986
Lübbert C
; Rodloff AC
; Hamed K
Infect Dis Ther
2015[Sep]; 4
(3
): 259-71
PMID26168986
show ga
INTRODUCTION: Evolution of antibacterial resistance in pathogenic enterococcal
strains poses a growing therapeutic challenge. Daptomycin, a cyclic lipopeptide,
exhibits broad antibiotic activity against Gram-positive bacteria. METHODS: The
European Cubicin(®) Outcomes Registry and Experience, a multicenter,
retrospective, non-interventional study, recorded clinical outcomes following
daptomycin treatment. RESULTS: Overall, 472 patients (predominantly elderly
Caucasian males) were treated for enterococcal infections. Of those, 72.7%
received antibiotics prior to daptomycin treatment, whereas 77.1% received other
antibiotics concomitantly. Failure of previous therapy, resistant or
non-susceptible pathogen, and narrowing of antibiotic therapy were the main
reasons for switching to daptomycin treatment. Nosocomial infections comprised
55.8% of the cohort. Bacteremia (29.9%), complicated skin and soft tissue
infection (29.2%) and endocarditis (12.3%) were the most common primary
infections. Clinical success was achieved in 77.1% of patients, with similar
success rates across all primary infection categories. The overall clinical
success rate was marginally higher (82.5% vs 74.6%, p = 0.09) with daptomycin use
as first-line versus second-line therapy. Patients receiving higher doses of
daptomycin exhibited the highest clinical success rates (85.7% for ?8 mg/kg/day
vs 75.8% for <8 mg/kg/day, p = 0.08). While 81 (17.2%) patients reported at least
one adverse event (AE), only 11 (2.3%) and 3 (0.6%) had treatment-related AEs and
serious AEs, respectively. Separate microbiologic findings from Leipzig
University Hospital demonstrate small proportions of Enterococcus faecium
isolates with daptomycin minimum inhibitory concentrations = 4 mg/L (4%)
or ?8 mg/L (0.8%), which are regarded as non-susceptible. CONCLUSION: For
enterococcal infections, daptomycin appears to be an effective and well-tolerated
treatment option, exhibiting highest clinical success rates at higher doses.