Indications for Daptomycin Use in Endocarditis and Pacemaker Lead Infection and Outcomes in Leeds, UK

Abstract

Infective endocarditis now comprises an increasingly complex mixture of endocardial infections, with staphylococci as the predominant cause. Although vancomycin has been an important therapeutic option for several decades, reduced susceptibility is emerging. Daptomycin is a relatively new antimicrobial agent, approved for right-sided endocarditis, but the data for other forms of endocarditis are limited. Here we report clinical data from the Leeds Endocarditis Service (Leeds, UK) for 19 patients treated with daptomycin between January 2007 and December 2009. The majority of cases were caused by staphylococci. All patients were treated with 6 mg/kg with a median treatment duration of 29 days. In total, 53% of patients were cured with antimicrobial regimens, which included daptomycin. Four patients (21%) died during therapy or within 30 days of stopping treatment. The current series is representative of everyday clinical practice and reflects the current difficulties in managing endocarditis.

Keywords:

• daptomycin
• endocarditis
• implantable cardiac device
• infection
• lipopeptide
• pacemaker
• staphylococci

Acknowledgements

The authors are grateful to D Gascoyne-Binzi and T English for developing and undertaking 16S polymerase chain reaction work, respectively. The authors thank P Verity for pulsed-field gel electrophoresis work.

Financial & competing interests disclosure

This report was supported by an unrestricted educational grant from Novartis UK. J Sandoe has received educational and/or research grants from Novartis, Merck Sharpe and Dohme Ltd, and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financialconflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript. Writing assistance was funded by an unrestricted education grant from Novartis UK. The authors would like to thank Annie Jones at MSC Ltd for the editorial support provided in the preparation of this report.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.