Daptomicina para el tratamiento de las infecciones por microorganismos grampositivos en el paciente crítico

Abstract

Introduction Infections caused by multiresistant Gram-positive cocci have increased among critically ill patients admitted to the intensive care unit (ICU). In the last few years, treatment of these infections has changed due to better knowledge of the limitations of glycopeptides and the introduction of novel antimicrobials, such as daptomycin. Objectives To describe the characteristics of daptomycin that justify its administration in critically ill patients and to present data on the use of this antibiotic in patients admitted to Spanish ICUs. Material and method We reviewed the literature on daptomycin to identify the characteristics that may favor clinical response in critically ill patients. To describe the indications and modalities of use in critically patients, information from the European Cubicin ® Outcome Registry and Experience (EUCORE) database of Spanish patients admitted to the ICU was employed. Results The following favorable conditions were identified: a) scarce systemic response, maintaining high bactericidal activity, b) scarce impact on renal function, c) no requirement for monitoring of plasma levels, d) scarce selection of resistance, and d) excellent tolerability. To assess indications and the use of this agent in the ICU, 122 patients from the EUCORE database were analyzed. The indications were bacteremias (36.2%), complicated infections of the skin and soft tissues (27.6%), and endocarditis (19%). Prominent pathogens were Staphylococcus aureus (26%), S. epidermidis (25%), and other coagulase-negative staphylococci (12%). In 85.7% of patients, treatment was administered as second-line (rescue treatment). In 65 patients (52%), a dose of 6 mg/kg/day was used, with a mean treatment duration of 10.2 days. Overall clinical efficacy was 73.7%. No adverse effects leading to treatment withdrawal were recorded and no increases in creatine phosphokinase (CPK) levels greater than 10-fold the initial values were observed. Conclusions Daptomycin is a novel therapeutic option to be considered in the treatment of severe infections caused by Gram-positive cocci in critically-ill patients.