Experience with the use of daptomycin in patients with infective endocarditis oncohematological and cardiosurgical profile

Abstract

The study of the effectiveness of antibacterial therapy with daptomycin in the treatment of gram-positive infection in 44 patients with infectious endocarditis was conducted. Primary infectious endocarditis developed in 15 patients, including 3 patients who were observed for oncohematological diseases (acute leukemia, myelodysplastic syndrome). In 29 patients secondary endocarditis was diagnosed, among the secondary forms of the disease endocarditis prevailed after cardiac surgery. In 32 patients, the bacteriological study revealed the pathogen. Among the identified pathogens included: 7 patients - methicillin-sensitive S. aureus,5 - methicillin-resistant S. aureus, 3 - methicillin-resistant S. Epidermidis in 9 - Enterococcus faecalis, 8 - Streptococcus bovis. All patients were prescribed antibacterial therapy with daptomycin, in monotherapy and in combination with beta-lactams, and surgical treatment was also performed. The average dose of daptomycin was 6,9±0,8 mg/kg/ day, the average duration of treatment 26,2±9,4 days. In 20 (45,4%) patients, repeated surgical treatment with a positive result were performed, there were no fatal outcomes among the operated patients. Of the 44 patients treated with daptomycin, 5 died (due to the inability to provide surgical treatment), in 1 case an early relapse of infectious endocarditis developed, in other cases there was a positive dynamics on the background of treatment, the resolution of infectious complications. No cases of resistance of the infectious agent to daptomycin have been reported. Thus, the use of daptomycin in the treatment of gram-positive infections in patients with cardiosurgical and oncohematological profile is justified and shows good results in tolerability and effectiveness both in monotherapy and in combination with other antibiotics.