Daptomycin – Vascular Graft Infections
Daptomycin is a lipopeptide antibiotic used as treatment for systemic infections caused by gram-positive organisms. Its compound occurs naturally from soil. And its unique mechanism of action makes it useful in treating infections caused by multiple drug resistance bacteria. Daptomycin mode of action disrupts bacterial cell membrane and inserted into where it then aggregates. The aggregation alters the curvature of the membrane which then creates leaks of ions resulting to the bacterial cell death. However, data on the clinical outcomes with vascular graft infection patients treated with Daptomycin are limited. This study is the pioneer describing Daptomycin used in the treatment of vascular graft infections caused by gram-positive organisms.
Daptomycin on Vascular Graft Infections
It isa retrospective cohort study of patients diagnosed with VGI receiving Daptomycin during the period January 2010 to December 2012. A total of 1066 patients underwent surgery at tertiary level hospital and among of 72 developed surgical site infections. And 25 have vascular graft infection which then treated with Daptomycin. These patients had previously existing episode of acute renal failure with glycopeptides allergy. The average dose of Daptomycin is 6.1 mg/kg/day. Even though, the current guidelines of the Infectious Disease Society of America recommended 8-10mg/kg/day for complicated bacteremia and endocarditis.
Daptomycin is also associated with rifampicin into the biofilm created by gram-negative microorganisms. But all patients given with rifampicin in addition to Daptomycin showed remission of infection. Yet those who did not receive rifampicin only Daptomycin showed only 50% remission of infection. All the patients in this study did not develop muscle toxicity due to the administration of Daptomycin. Since muscle toxicity is mostly reported to be linked with Daptomycin. As well as other side effects such as pneumonia and eosinophilic were not observed.
However, it appears that treatment of VGI with Daptomycin alone has similar effects with other antibiotics but with fewer side effects. Indeed, the use of Daptomycin as an antibiotic treatment for VGI caused by gram-positive bacteria is effective and well tolerated. It may be also serves as an alternative treatment for vascular graft infections particularly in patients with peripheral arterial disease whom renal insufficiency is common.
Sources: Prepared by Joan Tura from International Journal of Infectious Diseases
Volume 68, March 2018, Pages 69-73