title: Multidrug-resistant gram-positive infections in patients with ventricular assist devices: the role of daptomycin.
abstract: OBJECTIVE
  The rate of infection in patients who require ventricular assist devices (VADs) is estimated at more than 35%. Infections with multidrug-resistant (MDR) organisms in VAD recipients present a high mortality rate. Daptomycin (Cubicin, Novartis, Nuremberg, Germany), a new cyclic lipopeptide antibiotic, is useful for MDR gram-positive organisms. We report the successful use of daptomycin in patients presenting with MDR gram-positive infections after VAD implantation.
  
  
  METHODS
  We retrospectively studied nine consecutive patients presenting with resistant gram-positive infections after VAD implantation treated with daptomycin. We analyzed type of VAD, type of infection, responsible microorganism, outcome, and adverse events.
  
  
  RESULTS
  We studied nine patients (eight males, one female), of overall mean age of 51 +/- 8 years; 78% required a biventricular assist device or a left VAD (Berlin Heart, Berlin, Germany), 22% received other ventricular support. Sixty-six percent presented with catheter-related infections (CRIs). Therapy with daptomycin was empirically initiated in all cases. The initial dose was 6 mg/kg, continued at 4 mg/kg. The mean duration of therapy was 16 +/- 5 days. The reported pathogens were MRSA, 33%; E. faecium, 25%; methicillin-resistant staphylococcus epidermidis, 12.5%; methicillin-sensitive staphylococcus aureus, 12.5%; others, 17%. Successful outcomes were reported in seven subjects (78%), with two patients succumbing due to multiorgan failure related to their heart condition prior completing antibiotic therapy. No adverse events were reported.
  
  
  CONCLUSIONS
  Among our VAD patients, daptomycin proved efficient as a therapy for CRI with bacteremia. However, controlled studies are necessary to evaluate this antibiotic in patients presenting with VAD and MDR bacteremia.
authors.affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany. Andres.Beiras@med.uni-muenchen.de
authors.forename: A
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: F
authors.initials: F
authors.lastname: Kur
authors.forename: S
authors.initials: S
authors.lastname: Kiefer
authors.forename: R
authors.initials: R
authors.lastname: Sodian
authors.forename: M
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: M
authors.initials: M
authors.lastname: Weis
authors.forename: B
authors.initials: B
authors.lastname: Reichart
authors.forename: F
authors.initials: F
authors.lastname: Weis
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000453:epidemiology; D003402:Creatine Kinase / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D017576:Daptomycin / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007962:Leukocytes / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine; D003402:Creatine Kinase; D017576:Daptomycin