title: High-dose daptomycin for cardiac implantable electronic device-related infective endocarditis.
abstract: BACKGROUND
  Cardiac implantable electronic device (CIED)-related endocarditis is a growing challenge because of increasing incidence and significant mortality. Current treatment is based on complete hardware removal coupled with long-term administration of effective and safe antimicrobials. Daptomycin at the dose of 6 mg/kg/day has been found to be effective in staphylococcal endocarditis, but limited data exist on CIED endocarditis. Moreover, whether higher doses could be more effective but equally safe in this setting is currently unknown.
  
  
  METHODS
  We report here our experience with high-dose daptomycin in the treatment of 25 cases of CIED endocarditis due to staphylococci.
  
  
  RESULTS
  Patients were mostly elderly and male, with large lead vegetations and severe comorbidities. Pathogens were Staphylococcus epidermidis (56%), Staphylococcus aureus (28%), and other coagulase-negative staphylococci (16%). Only 4 patients (16%) had a normal pretreatment renal function. The median daptomycin daily dose was 8.3 mg/kg (range, 6.4-10.7). Daptomycin was administered for a median of 20 days (range, 8-52). Percutaneous lead extraction was performed in 88% of patients. Two patients (8%) failed to clear bacteremia. The overall clinical success of treatment was 80%, whereas a complete microbiological success was observed in 92% of patients. Creatine phosphokinase values were monitored and increased above normal in 5 cases (20%). No serious adverse event related to high-dose daptomycin was observed and no patient required discontinuation because of muscle toxicity.
  
  
  CONCLUSIONS
  Our experience suggests that high-dose daptomycin may be a safe therapeutic option in staphylococcal CIED endocarditis and may be associated with high microbiological responses and clinical success.
authors.affiliation: Department of Internal Medicine, University of Naples S.U.N., Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Durante-Mangoni
authors.forename: Roberta
authors.initials: R
authors.lastname: Casillo
authors.forename: Mariano
authors.initials: M
authors.lastname: Bernardo
authors.forename: Cristina
authors.initials: C
authors.lastname: Caianiello
authors.forename: Irene
authors.initials: I
authors.lastname: Mattucci
authors.forename: Daniela
authors.initials: D
authors.lastname: Pinto
authors.forename: Federica
authors.initials: F
authors.lastname: Agrusta
authors.forename: Roberta
authors.initials: R
authors.lastname: Caprioli
authors.forename: Rosina
authors.initials: R
authors.lastname: Albisinni
authors.forename: Enrico
authors.initials: E
authors.lastname: Ragone
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017576:Daptomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin