title: Tolerability of High Doses of Daptomycin in the Treatment of Prosthetic Vascular Graft Infection: A Retrospective Study.
abstract: BACKGROUND
  In treatment of prosthetic vascular graft infection (PVGI), appropriate antimicrobial treatment is crucial for controlling the septic process and preventing re-infection of the new graft. Glycopeptides are the mainstay of treatment for device-related infections by methicillin-resistant Staphylococcus aureus strains, but with some limitations, especially concerning vancomycin-intermediate and glycopeptide-intermediate S. aureus. We report our experience using a high dose of daptomycin (DAP) for treatment of PVGI.
  
  
  METHODS
  We reviewed medical reports of 26 patients treated with high doses of DAP (>8 mg/kg) and beta-lactams/aminosides for PVGI, defined as positive bacterial culture of intraoperative specimens or blood samples and/or clinical, biological, and radiological signs of infection. Clinical success was defined by resolution of all clinical signs at the end of follow-up, without the need for additional antibiotic therapy, and/or negative culture in case of new surgery.
  
  
  RESULTS
  Cultures of intraoperative samples were positive in 21 patients (80.8%). Blood and intraoperative cultures were concomitantly positive in 10 patients. The main microorganism identified in microbiological samples was S. aureus (n = 18). Surgery was performed in 23 patients (88.4%). The mean duration of the DAP regimen was 12.3 ± 11.9 days. DAP was discontinued in 26 patients [need to switch to microbiological results (n = 19), bacterial pneumonia (n = 2), and increased creatine phosphokinase levels (n = 4)]. One patient had myalgia, while 9 received concomitant statins.
  
  
  CONCLUSIONS
  High-dose DAP therapy shows a satisfactory toxicity profile even in severely ill patients with multiple comorbidities, and may favorably compete with vancomycin, especially concerning the risk of induced nephrotoxicity.
authors.affiliation: Infectious Diseases Department, Dron Hospital, Tourcoing, France. laurence.legout@free.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Legout
authors.affiliation: Department of Vascular Surgery, Dron Hospital of Tourcoing, Tourcoing, France.|Department of Vascular Surgery, University Hospital of Lille, Lille, France.
authors.forename: Piervito
authors.initials: P
authors.lastname: D'Elia
authors.affiliation: Department of Vascular Surgery, Dron Hospital of Tourcoing, Tourcoing, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Sarraz-Bournet
authors.affiliation: Infectious Diseases Department, Dron Hospital, Tourcoing, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ettahar
authors.affiliation: Department of Vascular Surgery, University Hospital of Lille, Lille, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Intensive Care and Infectious Diseases Unit, Dron Hospital of Tourcoing, Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
authors.affiliation: Infectious Diseases Department, Dron Hospital, Tourcoing, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Senneville
keywords: Biofilm; Daptomycin; Prosthetic vascular graft infection; Staphylococcal infection; Staphylococcus aureus