Daptomycin for the treatment of major gram-positive infections after cardiac surgery.

A Kornberger,A Beiras-Fernandez,F Weis,M Weis,B Luchting,F Kur,U A Stock

doi:10.1186/s13019-016-0519-7

Abstract

BackgroundInfection is a main cause of morbidity and mortality after heart surgery, with multi-resistant pathogens increasingly representing a challenge. Daptomycin provides bactericidal activity against gram-positive organisms that are resistant to standard treatment including vancomycin.MethodsA cohort of cardiac surgical patients, treated with daptomycin for major infection at two tertiary care centers, were retrospectively studied with a particular focus on the type of infection, causative pathogens and co-infections, daptomycin dosage, adverse events and outcome in order to provide evidence for the efficiency and safety of daptomycin in a distinct high-risk patient population.ResultsSixty-five patients (87.7 % males, 60.4 ± 13.5 years) who had undergone aortic surgery (20.0 %), ventricular assist device (VAD) implantation (21.5 %), combined procedures (21.5 %), coronary artery bypass grafting (12.3 %), isolated valve surgery (15.4 %) and heart transplantation (7.7 %) were diagnosed with catheter-related infection (26.1 %), valve endocarditis (18.8 %), sternal wound (13.0 %), VAD-associated (11.6 %), cardiac implantable electrophysiological device (CIED)-associated (4.1 %), respiratory tract (4.3 %), bloodstream (4.3 %) and other infection (4.3 %). In 13.0 %, no focus of infection was identified though symptoms of severe infection were present. The most frequent pathogens were Staphylococcus epidermidis (30.4 %), Staphylococcus aureus (23.1 %) and Enterococcus species (10.1 %). Daptomycin doses ranging from 3 mg/kg every 48 h to 10 mg/kg every 24 h were administered for 15.4 ± 11.8 days. 87.0 % of the cases were classified as success, 7.2 % as treatment failure and 5.8 as non-evaluable. Adverse events were limited to one case of mild and one case of moderate neutropenia with recovery upon termination of treatment.ConclusionDaptomycin proved safe and effective in major infection in high-risk cardiac surgical patients.

Highlights

Infection is a main cause of morbidity and mortality after heart surgery, with multi-resistant pathogens increasingly representing a challenge
Major infection is a severe complication in cardiac surgical patients and may consist of sternal wound infection, bloodstream or catheter-related infection, native or prosthetic valve endocarditis, or infection associated with other implantable devices such as cardiac implantable electrophysiological device (CIED), ventricular assist device (VAD) or vascular prosthetic material
With 87.0 % of the cases assessed as clinical success and 7.2 % as treatment failure, our current results are comparable to the success and failure rates of 79 and 7.5 % reported by the European Cubicin Outcome Registry and Experience EU-US-based cubicin Outcomes Registry and Experience (CORE) [33]

Summary

Introduction

Infection is a main cause of morbidity and mortality after heart surgery, with multi-resistant pathogens increasingly representing a challenge. Daptomycin provides bactericidal activity against gram-positive organisms that are resistant to standard treatment including vancomycin. Major infection is a severe complication in cardiac surgical patients and may consist of sternal wound infection, bloodstream or catheter-related infection, native or prosthetic valve endocarditis, or infection associated with other implantable devices such as CIEDs, VADs or vascular prosthetic material. Recent investigations of large patient cohorts showed incidences of major infection after cardiac. Vancomycin, the first-choice drug used against methicillin-resistant gram-positive pathogens, is associated with considerable side effects. Vancomycin does not achieve high tissue levels and has limited activity in the biofilm layer on implanted materials. The introduction of alternative substances such as linezolid, tigecyclin, quinupristin-dalfopristin and daptomycin has met with particular interest [23]

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