title: Brazilian experience in EU-CORE: daptomycin registry and treatment of serious Gram-positive infections.
abstract: OBJECTIVE
  To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes.
  
  
  METHODS
  This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011) to collect data on 120 patients (44 patients in the first year and 76 patients in the second year) who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection.
  
  
  RESULTS
  Right-sided endocarditis (15.8%), complicated skin and soft tissue infections (cSSTI)-wound (15.0%) and bacteremia-catheter-related (14.2%) were the most frequent primary infections; lung (21.7%) was the most common site for infection. Daptomycin was used empirically in 76 (63.3%) patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the most common suspected pathogen (86.1%). 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively). The most common daptomycin dose administered for bacteremia and cSSTI was 6mg/kg (30.6%) and 4mg/kg (51.7%), respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1%) did not receive daptomycin while in intensive care unit. Carbapenem (22.5%) was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median) following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%), switched therapy (11.7%), and treatment failure (4.2%). Daptomycin demonstrated a favorable safety and tolerability profile regardless of treatment duration.
  
  
  CONCLUSIONS
  Daptomycin had a relevant role in the treatment of Gram-positive infections in the clinical practice setting in Brazil.
authors.affiliation: Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil. Electronic address: artur.timerman@globo.com.
authors.forename: Artur
authors.initials: A
authors.lastname: Timerman
authors.forename: Carlos
authors.initials: C
authors.lastname: Brites
authors.forename: Eliana
authors.initials: E
authors.lastname: Bicudo
authors.forename: Renato S
authors.initials: RS
authors.lastname: Grinbaum
authors.forename: Rubens
authors.initials: R
authors.lastname: Costa Filho
authors.forename: Claudia D M
authors.initials: CD
authors.lastname: Carrilho
authors.forename: Andre
authors.initials: A
authors.lastname: Bichels
authors.forename: Tânia
authors.initials: T
authors.lastname: Barreto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001938:Brazil; D017576:Daptomycin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: Bacteremia; Daptomycin; Endocarditis; Infectious; Methicillin-resistant; Skin diseases; Staphylococcus aureus
references.citation: BMC Infect Dis. 2012 Jun 12;12:133
references.pmid: 22691420
references.citation: Clin Ther. 2012 Jul;34(7):1521-7
references.pmid: 22748973
references.citation: Infect Drug Resist. 2011;4:115-27
references.pmid: 21753891
references.citation: Diagn Microbiol Infect Dis. 2010 Apr;66(4):441-4
references.pmid: 20226335
references.citation: Enferm Infecc Microbiol Clin. 2012 Feb;30 Suppl 1:38-42
references.pmid: 22541974
references.citation: Eur J Intern Med. 2009 Jul;20(4):343-7
references.pmid: 19524170
references.citation: Med Clin (Barc). 2010 Dec;135 Suppl 3:36-47
references.pmid: 21477703
references.citation: Diagn Microbiol Infect Dis. 2011 Jul;70(3):373-9
references.pmid: 21683269
references.citation: J Chemother. 2012 Apr;24(2):113-21
references.pmid: 22546768
references.citation: Enferm Infecc Microbiol Clin. 2011 Jun-Jul;29(6):425-7
references.pmid: 21501905
references.citation: Surgery. 2009 Aug;146(2):316-24
references.pmid: 19628091
references.citation: Am J Med Sci. 2011 Dec;342(6):486-8
references.pmid: 21709538
references.citation: Enferm Infecc Microbiol Clin. 2012 Feb;30 Suppl 1:54-8
references.pmid: 22541977
references.citation: Pharmacotherapy. 2011 Jul;31(7):665-72
references.pmid: 21923453
references.citation: Emerg Infect Dis. 2004 Sep;10(9):1627-34
references.pmid: 15498166
references.citation: Enferm Infecc Microbiol Clin. 2012 Feb;30 Suppl 1:43-9
references.pmid: 22541975
references.citation: Clin J Am Soc Nephrol. 2011 May;6(5):1081-8
references.pmid: 21393490
references.citation: Braz J Infect Dis. 2009 Apr;13(2):90-8
references.pmid: 20140350
references.citation: Curr Opin Infect Dis. 2012 Aug;25(4):385-94
references.pmid: 22614523
references.citation: Clin Infect Dis. 2004 Jun 15;38(12):1673-81
references.pmid: 15227611
references.citation: Clin Adv Hematol Oncol. 2010 Apr;8(4):249-56, 90
references.pmid: 20505648
references.citation: J Antimicrob Chemother. 2011 Apr;66(4):912-9
references.pmid: 21393205
references.citation: N Engl J Med. 2006 Aug 17;355(7):653-65
references.pmid: 16914701
references.citation: Antimicrob Agents Chemother. 2012 Nov;56(11):5626-32
references.pmid: 22908174
references.citation: Am J Geriatr Pharmacother. 2010 Dec;8(6):551-61
references.pmid: 21356504
references.citation: J Chemother. 2008 Oct;20(5):531-41
references.pmid: 19028614
references.citation: Ann Pharmacother. 2012 Apr;46(4):495-502
references.pmid: 22454446
references.citation: Drugs. 2006;66(8):1089-105
references.pmid: 16789794