title: Cardiovascular implantable electronic device endocarditis treated with daptomycin with or without transvenous removal.
abstract: METHODS
  Nine patients with cardiovascular implantable electronic device (CIED) endocarditis were treated with daptomycin after the failure of previous treatment. The blood and CIED lead cultures of 1 patient were negative. In the other 8 patients, we observed 6 monomicrobic infections and 2 polymicrobic infections. Overall, 10 strains were isolated in these patients: 4 methicillin-sensitive Staphylococcus aureus, 2 methicillin-sensitive Staphylococcus epidermidis, 1 methicillin-resistant Staphylococcus aureus, 1 methicillin-resistant Staphylococcus epidermidis, 1 methicillin-sensitive Staphylococcus hominis, and 1 Propionibacterium acnes. The CIED was removed transvenously in 7 patients. Two patients were too sick for the removal of their CIED, and were cured with 6 mg/kg of daptomycin for 60 and 110 days, respectively, without adverse events.
  
  
  RESULTS
  One patient died 4 days after the removal of his CIED because of a complicated abdominal aortic aneurysm. The other 8 patients were cured, with a mean follow-up of 17 ± 8 months. The removed leads were negative, after daptomycin therapy, in 4 cases out of 7. The mean ratio between peak daptomycin concentration and minimal inhibitory concentration (MIC) of the causative strains was 38.3 ± 18.5. For patients whose data were available, the ratio between peak daptomycin concentration and minimal bactericidal concentration (MBC) was 13.2 ± 3.2.
  
  
  CONCLUSIONS
  Daptomycin monotherapy may be a useful therapeutic tool in difficult-to-treat CIED endocarditis, resulting in a high rate of cures and sterilized leads removed. The ratio between peak daptomycin concentration and MIC or MBC may be useful as predictive tool for treatment success.
authors.affiliation: Unità Operativa Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.forename: Antonello
authors.initials: A
authors.lastname: Di Paolo
authors.forename: Marina
authors.initials: M
authors.lastname: Polidori
authors.forename: Enrico
authors.initials: E
authors.lastname: Tagliaferri
authors.forename: Serena
authors.initials: S
authors.lastname: Fondelli
authors.forename: Ezio
authors.initials: E
authors.lastname: Soldati
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ciullo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Leonildi
authors.forename: Romano
authors.initials: R
authors.lastname: Danesi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coluccia
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017576:Daptomycin / Q000627:therapeutic use*; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects* / Q000382:microbiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin