Use of daptomycin in a pregnant patient with Staphylococcus aureus endocarditis.
OBJECTIVE
To report on 6 weeks of daptomycin treatment for tricuspid valve endocarditis caused by Staphylococcus aureus in a pregnant female in her second trimester.


METHODS
A 24-year-old, 14-week pregnant patient with no significant medical history, but with a history of intravenous drug abuse presented with tricuspid valve endocarditis caused by methicillin-sensitive S. aureus. After initial treatment with vancomycin, the patient continued to have fever and bacteremia and was initiated on daptomycin 6 mg/kg for 6 weeks of therapy. The treatment resulted in the resolution of the endocarditis, and no adverse sequelae were identified in the mother or baby.


CONCLUSIONS
Infective endocarditis is a common infection encountered in the hospital setting and represents an increased cost burden to institutions due to prolonged lengths of treatment. Antimicrobial resistance, antimicrobial failure, inadequate attainment of effective drug concentrations, drug allergies, and adverse reactions may be factors that limit the use of commonly utilized antimicrobial agents. Therefore, newer therapies like daptomycin may need to be employed in these situations. Although daptomycin is pregnancy category B, limited case reports with neonatal outcomes are reported.


CONCLUSIONS
This case provides further support for the safety of daptomycin in pregnancy with the dose of 6 mg/kg, the extended duration of therapy (6 weeks), and the primary exposure in the second trimester.
Stroup
Jeffrey S
JS
Oklahoma State University Center for Health Sciences, Tulsa, OK 74127, USA. Jeffrey.Stroup@okstate.edu
Wagner
James
J
Badzinski
Terry
T
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use*; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005334:Fever / Q000209:etiology; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008826:Microbial Sensitivity Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology; D011256:Pregnancy Outcome; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D014261:Tricuspid Valve; D055815:Young Adult
D000900:Anti-Bacterial Agents; D017576:Daptomycin