Abstract
Background: infective endocarditis (IE) remains a severe disease frequently encountered in clinical practice and often requiring interdisciplinary medical and surgical management. This national survey aims to describe the clinical prescribing habits of the use of daptomycin in the setting of IE and the possible role for combination therapy with beta-lactams. Methods: The study was a cross-sectional internet-based questionnaire survey on therapy with daptomycin. The questionnaire was designed with closed-ended questions and distributed using the SurveyMonkey® platform between October 2019 to December 2020. Results: 55 clinicians from twelve Italians regions joined the questionnaire. The survey reported use of daptomycin as first-line choice in 31.48% of cases and as the first-line anti-MRSA agent in 44.44%. The empiric use of daptomycin was stated in the high suspicion of MRSA rather than MSSA, enterococcal or streptococcal IE. The rationale of daptomycin for the empirical treatment of native and prosthetic valve IE was mostly the possibility of administering an aminoglycoside-sparing combination regimen, high bacterial killing rate and high clinical efficacy. Conclusions: In conclusion, in selected patients, daptomycin could be a feasible option for the treatment of infective endocarditis in line with data from the European registry of daptomycin.
Highlights
Infective endocarditis (IE) remains a severe disease frequently encountered in clinical practice and often requiring interdisciplinary medical and surgical management [1,2,3,4,5]
Our survey aimed to explore the prescribing habits for the management of IE involving the use of daptomycin, with a particular interest in beta-lactam plus daptomycin combination therapy for IE, as prescribed by infectious diseases (ID) and internal medicine physicians in Italy between 2019 and 2020
Our results showed that respondents mainly worked within large (≥500 beds) university hospitals that frequently included an ICU and neuro/cardio-surgical unit, and they had access to ID consultants or antibiotic guidelines
Summary
The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) implemented the European Endocarditis (EURO-ENDO) international registry, confirming the high prevalence of gram-positive microorganisms involved in both native and prosthetic valve endocarditis [6,7]: Staphylococcus spp., oral streptococci, Enterococcus spp., and Streptococcus gallolyticus are the most common pathogens in this registry [6,7]. The IE population has been transforming, with increasing incidence in elderly adults, highly comorbid patients and prosthetic heart valve cases [1,2,3,6,7]. IE in this population requires effective and manageable therapies according to the frailty. Frail patients are characterized by high morbidity and mortality and puts the subjects at greater risk of developing adverse antibiotic effects [1,2,3,6,7]
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