大剂量达托霉素和头孢曲松联合治疗心脏植入式电子设备感染：十年经验

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2024-10-01 DOI:10.1016/j.clinthera.2024.07.012

Giacomo Ponta , Martina Ranzenigo , Alessandra Marzi , Chiara Oltolini , Chiara Tassan Din , Caterina Uberti-Foppa , Vincenzo Spagnuolo , Patrizio Mazzone , Paolo Della Bella , Paolo Scarpellini , Antonella Castagna , Marco Ripa

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引用次数: 0

摘要

目的：心脏植入式电子设备（CIED）感染越来越常见。凝固酶阴性葡萄球菌和金黄色葡萄球菌等革兰氏阳性细菌是最常见的病原体。本研究旨在描述接受装置移除手术并接受大剂量（每天 8-12 毫克/千克）达托霉素（DAP）联合头孢曲松（CRO）经验性治疗的 CIED 感染患者的特征和预后：2011年6月至2021年6月期间，意大利米兰IRCCS圣拉斐尔医院收治了因CIED感染而接受装置移除手术并接受DAP/CRO经验性治疗的患者：本研究共纳入 147 名患者。中位治疗时间为 16 天（IQR 14-26）。有 140 名患者（95.2%）确诊接受了 DAP/CRO 经验性治疗。7例（4.8%）患者根据明确的微生物分离结果停用了 DAP/CRO：科里奈杆菌属（4 例）、铜绿假单胞菌（2 例）、泄殖腔肠杆菌（1 例）。10 名患者（6.8%）接受了简化治疗，改用窄谱抗生素。一名患者（0.6%）因泛红细胞减少而中断了 DAP-CRO。对 123/147 名患者（83.7%）进行了为期 6 个月的随访：9名患者复发了CIED感染（7.3%），9名患者死亡（7.3%）：在我们10年的经验中，大剂量DAP联合CRO是经验性治疗CIED感染的良好选择。DAP-CRO联合用药安全有效，无明显药物相关不良反应，6个月复发率和死亡率较低。

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Combination of High-Dose Daptomycin and Ceftriaxone for Cardiac Implantable Electronic Device Infections: A 10-Year Experience

Purpose

Cardiac implantable electronic device (CIED) infections are increasingly common. Gram-positive bacteria such as coagulase negative staphylococci and Staphylococcus aureus are the most commonly involved pathogens. The aim of this study was to describe the characteristics and outcome of patients with CIED infections who underwent device removal and were empirically treated with high dose (8–12 mg/kg daily) daptomycin (DAP) in combination with ceftriaxone (CRO).

Methods

Retrospective, single center study including patients admitted at IRCCS San Raffaele Hospital (Milan, Italy), from June 2011 to June 2021, who underwent device removal for CIED infection and were empirically treated with DAP/CRO.

Findings

Overall, 147 patients were included in this study. Median duration of therapy was 16 days (IQR 14–26). Empirical treatment with DAP/CRO was confirmed as definitive treatment in 140 patients (95.2%). In 7 (4.8%) patients DAP/CRO were discontinued according to the definite microbiological isolates: Corynebacterium spp. (4), Pseudomonas aeruginosa (2), Enterobacter cloacae (1). Ten patients (6.8%) underwent treatment simplification to narrow-spectrum antibiotics. One patient (0.6%) interrupted DAP-CRO due to pancytopenia.

6-month follow-up was available for 123/147 patients (83.7%): 9 patients recurred with a CIED infection (7.3%), and 9 died (7.3%).

Implications

In our 10-year experience, high-dose DAP in combination with CRO represented a good option for empirical therapy of CIED infections. DAP-CRO combination was safe and effective, showing no significant drug-related adverse events and low rates of 6-month recurrence and mortality.

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.