title: Daptomycin for the treatment of infective endocarditis: results from a European registry.
abstract: OBJECTIVE
  Infective endocarditis (IE) is a complex infection associated with high mortality. Daptomycin, a cyclic lipopeptide antibiotic highly active against Gram-positive bacteria, has recently been incorporated into IE treatment guidelines. This retrospective analysis provides insights into the use of daptomycin in IE in the European Cubicin(®) Outcomes Registry Experience (EU-CORE(SM)) between 2006 and 2010.
  
  
  METHODS
  Three hundred and seventy-eight (10%) of 3621 enrolled patients received daptomycin for treatment of IE. Two hundred and fifty-nine (69%) had left-sided IE (LIE) and 182 patients (48%) underwent concomitant surgery.
  
  
  RESULTS
  Staphylococcus aureus was the most frequently identified pathogen (n=92; methicillin susceptible, n=50) and daptomycin was used empirically in 134 patients. Among cases of second-line therapy (n=312), the most common reason for switching to daptomycin was failure of the previous regimen (including glycopeptides and penicillins). Daptomycin was administered at 6 mg/kg in 224 patients and at ≥ 8 mg/kg in 72 patients. Clinical success rates were 80% overall, 91% for right-sided IE (RIE) and 76% for LIE, with similar rates seen for infections caused by methicillin-susceptible S. aureus (84%) and methicillin-resistant S. aureus (81%). The clinical success rate in patients treated with ≥ 8 mg/kg daptomycin was 90% [n=72 (RIE, 91%; LIE, 89%)]. No new safety signals were observed.
  
  
  CONCLUSIONS
  In patients with IE registered in EU-CORE, daptomycin was most frequently used as second-line treatment after treatment failure. The majority of patients had LIE and most commonly received daptomycin for the treatment of staphylococcal infections. Clinical success was high in this difficult-to-treat population. The role of doses ≥ 8 mg/kg per day in the empirical treatment of IE deserves further investigation.
authors.affiliation: Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany. pascal.dohmen@yahoo.de
authors.forename: Pascal M
authors.initials: PM
authors.lastname: Dohmen
authors.forename: Achyut
authors.initials: A
authors.lastname: Guleri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capone
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Seaton
authors.forename: Víctor José
authors.initials: VJ
authors.lastname: González-Ramallo
authors.forename: Rashidkhan
authors.initials: R
authors.lastname: Pathan
authors.forename: Markus
authors.initials: M
authors.lastname: Heep
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Chaves
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use*; D004696:Endocarditis / Q000188:drug therapy*; D005060:Europe; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin