title: Efficacy of daptomycin lock therapy in the treatment of bloodstream infections related to long-term catheter.
abstract: BACKGROUND
  Concomitant systemic and intracatheter antibiotic therapy is a therapeutic option for catheter-related bloodstream infections (CRBSI) in patient fitted with long-term intravenous central catheters. CRBSI are mainly caused by Gram-positive bacteria. Daptomycin (DPT) is an antibiotic active against Gram-positive bacteria with high bactericidal activity and good biofilm penetration.
  
  
  OBJECTIVE
  To study the efficacy of DPT given systemically and as lock therapy in the treatment of CRBSI.
  
  
  METHODS
  A retrospective review was conducted of adult patients with a long-term central venous catheter (CVC) receiving both systemic intravenous and intracatheter lock therapy for CRBSI. The primary outcome was catheter maintenance, following clinical success and microbiological eradication.
  
  
  RESULTS
  Eight patients who had failed previous standard therapy (vancomycin 7, cefazolin 1) were included in the study. In all but one, coagulase-negative staphylococci were repeatedly isolated. The other patient had enterococcal infection. DPT, given intravenously and as lock therapy, was successful in six of eight cases. The mean time to negative blood cultures was 2 days (range 1-6). In two cases neither clinical nor microbiological response was documented and the catheter was removed.
  
  
  CONCLUSIONS
  Systemic and intracatheter therapy with DPT is feasible, carries no toxicity and is apparently effective. DPT might be a suitable therapeutic option in CRBSI to achieve CVC sterilization and preserve the catheter.
authors.affiliation: Division of Infectious Diseases, San Martino University Hospital, University of Genoa, Genoa, Italy, paolatatarelli@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Tatarelli
authors.forename: A
authors.initials: A
authors.lastname: Parisini
authors.forename: V
authors.initials: V
authors.lastname: Del Bono
authors.forename: M
authors.initials: M
authors.lastname: Mikulska
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy*; D055499:Catheter-Related Infections / Q000188:drug therapy*; D062905:Central Venous Catheters / Q000009:adverse effects*; D017576:Daptomycin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
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