Factors Associated with Daptomycin-Induced Eosinophilic Pneumonia.

Kazuhiro Ishikawa,Mahbubur Rahman,Takahiro Matsuo,Yasumasa Tsuda,Yuki Uehara,Nobuyoshi Mori

doi:10.3390/antibiotics11020254

Kazuhiro Ishikawa, Mahbubur Rahman + Show 4 more

Open Access

https://doi.org/10.3390/antibiotics11020254

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Abstract

The risk factors for eosinophilic pneumonia (EP) remain unclear. We investigate the characteristics of patients with daptomycin (DAP)-induced EP and conducted a retrospective observational study. A total of 450 patients aged ≥ 18 years who received DAP (25 DAP with EP, 425 DAP without EP) were included. The median duration from the first DAP administration to EP onset was 18.0 days. Definite, probable, and possible DAP-induced EP were diagnosed in 0, 9, and 16 patients, respectively. The median age (DAP with EP, 72.0 years; DAP without EP, 64.0 years), DAP dosage/body weight (BW) (9.00 vs. 7.50 mg/kg), blood eosinophil count (cells/μL) (419 vs. 96), and the percentage of hemodialyzed patients (40.0% vs. 13.4%) were significantly higher in patients with EP than in patients without EP in the univariate analysis. In separate multivariate logistic regression analyses, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.00–1.05), DAP dosage/BW (OR, 1.61; 95% CI, 1.25–2.07), and hemodialysis (OR, 4.42; 95% CI, 1.86–10.5) were significantly associated with DAP-induced EP. Clinicians may need to consider the potential factors associated with EP, especially in older patients, patients on hemodialysis, or patients who receive > 9.00 mg/kg of DAP.

Highlights

Methicillin-resistant Staphylococcus aureus (MRSA) infections have high mortality rates of 15–25% [1,2]
Age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.00–1.05), DAP dosage/body weight (BW) (OR, 1.61; 95% CI, 1.25–2.07), and hemodialysis (OR, 4.42; 95% CI, 1.86–10.5) were significantly associated with DAPinduced eosinophilic pneumonia (EP)
We observed that hemodialysis and dosage/BW are associated with EP

Summary

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) infections have high mortality rates of 15–25% [1,2]. The standard treatment for MRSA bacteremia is vancomycin (VCM) or daptomycin (DAP) [3]. DAP is bactericidal and is considered to be more effective than VCM for MRSA infections; this was observed in a previous study where a higher the duration of negative blood cultures was observed with DAP than VCM [4]. DAP has a high protein-binding concentration of 90–93%, a long half-life in blood (about 8.5 h), and is excreted by the kidneys. The elevation of creatine kinase (CK) levels and eosinophilic pneumonia (EP) are side effects of DAP [5]

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