Daptomycin Lock Therapy for Catheter-related Sepsis
Daptomycin Lock Therapy for Catheter-related Sepsis
Introduction: To evaluate the efficacy of Daptomycin (DPT) lock therapy in the treatment of Grampositive long-term catheter-related bloodstream infections (LT-CRBI).
Patients and methods: A retrospective review of all patients receiving DPT lock therapy for the treatment of LT-CRBI from December 2009 to May 2010 was conducted. The primary endpoint used in this study was failure to cure the episode of LT-CRBI. Cure was defined as fever disappearance, negative blood cultures within 1 month after the end of treatment, and catheter salvage.
Results: Thirteen subjects (seven men, mean age 62 years) were evaluated. There were six Staphylococcus epidermidis, two Staphylococcus hominis, one Staphylococcus haemolyticus, two Enterococcus faecalis and two polymicrobial (S. epidermidis and S. hominis) bloodstream infections. DPT lock therapy was administered for a mean of 14 days (interquartilic range 10–14). Intravenous DPT was administered in nine patients for a mean of 10 days (interquartilic range 5–11). Clinical cure and blood culture sterilisation occurred in 11 of 13 patients (85%). Two patients had fever during treatment and catheters were removed. Median length of follow-up in patients with therapeutic success was 67 days (interquartilic range 14–88).
Conclusion: DPT lock therapy demonstrated good in vivo efficacy in LT-CRBI caused by coagulase negative staphylococci and Enterococcus species.
Long-term catheter use has increased over the last decade and nowadays they are commonly used in the management of haemodialysis and oncology patients. Use of long-term central venous catheters may be compromised by an increased risk of bloodstream infections, which are associated with prolonged hospitalisation, increased patient morbi-mortality and excessive hospital-related costs. Removal of a surgically implantable vascular device is often a management challenge, and it is important to determine the role of conservative approaches, trying to avoid catheter removal. The most common route of infection in long-term catheters is through the hub, and this fact supports antimicrobial lock therapy as a suitable treatment approach. The Infectious Diseases Society of America guidelines on the management of catheter-related bloodstream infections suggests the use of antibiotic lock therapy for the salvage of central venous catheters associated with catheter-related bloodstream infections. However, these guidelines failed to specify which antibiotics are more active in the biofilm environment and how long the antibiotic should be locked in.
Gram-positive organisms, predominantly Staphylococcus aureus and coagulase negative staphylococci, account for nearly 70% of catheter-related bloodstream infections. Staphylococci embed themselves in the biofilm layer in the lumen of the catheter where they are protected from antimicrobial action. Vancomycin is considered the agent of choice to perform antimicrobial locks when staphylococci are involved. The expanding use of central venous catheters combined with a growing concern over drug-resistant pathogens warrants study of further options with novel lock solutions in the treatment of catheter-related bloodstream infections. Antibiotics to be used should be active against organisms embedded in biofilm. Daptomycin (DPT) is a cyclic lipopeptide antibiotic with potent activity against Grampositive microorganisms and approved for treatment of bacteremia/endocarditis caused by S. aureus. Time-kill studies have demonstrated that DPT is more rapidly bactericidal than vancomycin. DPT has shown high in vitro efficacy in eradicating staphylococcal species embedded in biofilms. However, literature on efficacy of DPT in this setting is limited. The aim of this study was to assess the efficacy of DPT lock therapy in the treatment of long-term catheter-related bloodstream infections (LT-CRBI) keeping the catheter in site.
Abstract and Introduction
Abstract
Introduction: To evaluate the efficacy of Daptomycin (DPT) lock therapy in the treatment of Grampositive long-term catheter-related bloodstream infections (LT-CRBI).
Patients and methods: A retrospective review of all patients receiving DPT lock therapy for the treatment of LT-CRBI from December 2009 to May 2010 was conducted. The primary endpoint used in this study was failure to cure the episode of LT-CRBI. Cure was defined as fever disappearance, negative blood cultures within 1 month after the end of treatment, and catheter salvage.
Results: Thirteen subjects (seven men, mean age 62 years) were evaluated. There were six Staphylococcus epidermidis, two Staphylococcus hominis, one Staphylococcus haemolyticus, two Enterococcus faecalis and two polymicrobial (S. epidermidis and S. hominis) bloodstream infections. DPT lock therapy was administered for a mean of 14 days (interquartilic range 10–14). Intravenous DPT was administered in nine patients for a mean of 10 days (interquartilic range 5–11). Clinical cure and blood culture sterilisation occurred in 11 of 13 patients (85%). Two patients had fever during treatment and catheters were removed. Median length of follow-up in patients with therapeutic success was 67 days (interquartilic range 14–88).
Conclusion: DPT lock therapy demonstrated good in vivo efficacy in LT-CRBI caused by coagulase negative staphylococci and Enterococcus species.
Introduction
Long-term catheter use has increased over the last decade and nowadays they are commonly used in the management of haemodialysis and oncology patients. Use of long-term central venous catheters may be compromised by an increased risk of bloodstream infections, which are associated with prolonged hospitalisation, increased patient morbi-mortality and excessive hospital-related costs. Removal of a surgically implantable vascular device is often a management challenge, and it is important to determine the role of conservative approaches, trying to avoid catheter removal. The most common route of infection in long-term catheters is through the hub, and this fact supports antimicrobial lock therapy as a suitable treatment approach. The Infectious Diseases Society of America guidelines on the management of catheter-related bloodstream infections suggests the use of antibiotic lock therapy for the salvage of central venous catheters associated with catheter-related bloodstream infections. However, these guidelines failed to specify which antibiotics are more active in the biofilm environment and how long the antibiotic should be locked in.
Gram-positive organisms, predominantly Staphylococcus aureus and coagulase negative staphylococci, account for nearly 70% of catheter-related bloodstream infections. Staphylococci embed themselves in the biofilm layer in the lumen of the catheter where they are protected from antimicrobial action. Vancomycin is considered the agent of choice to perform antimicrobial locks when staphylococci are involved. The expanding use of central venous catheters combined with a growing concern over drug-resistant pathogens warrants study of further options with novel lock solutions in the treatment of catheter-related bloodstream infections. Antibiotics to be used should be active against organisms embedded in biofilm. Daptomycin (DPT) is a cyclic lipopeptide antibiotic with potent activity against Grampositive microorganisms and approved for treatment of bacteremia/endocarditis caused by S. aureus. Time-kill studies have demonstrated that DPT is more rapidly bactericidal than vancomycin. DPT has shown high in vitro efficacy in eradicating staphylococcal species embedded in biofilms. However, literature on efficacy of DPT in this setting is limited. The aim of this study was to assess the efficacy of DPT lock therapy in the treatment of long-term catheter-related bloodstream infections (LT-CRBI) keeping the catheter in site.