在儿科患者中使用达托霉素的真实世界临床特征和结果:回顾性病例系列

Hanna Persha, Stephen A. Thacker, Krutika Mediwala Hornback, Gustavo R. Alvira-Arill, Richard Lueking, Taylor Morrisette
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摘要

简介达托霉素(DAP)是一种环状脂肽,对许多耐药革兰氏阳性菌(包括耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素肠球菌(VRE))具有很强的体外活性。尽管有大量报告评估了 DAP 在成人人群中的临床效果,但缺乏儿童的实际数据。本次评估的主要目的是描述儿科患者在各种感染中使用 DAP 的临床特征和疗效。方法:这项回顾性评估纳入了 2014 年 1 月至 2023 年 5 月期间接受 DAP 治疗的年龄小于 18 岁的患者。首要目标是评估综合临床成功率,其定义为 30 天存活率、30 天内无微生物复发、急性感染症状和体征消失且未根据临床失败情况调整治疗方案。次要目标包括可能由 DAP 引起的不良反应以及使用 DAP 的原因。结果:共纳入 40 名患者,其中男性(62.5%)和白人(52.5%)占多数,中位年龄为 8.7 [IQR,4.4-16.0]岁。DAP 用于多种感染,包括中心静脉相关血流感染(CLABSIs;32.5%)、感染性心内膜炎(15.0%)、手术部位感染(12.5%)和骨髓炎(12.5%)。分离出的最常见病原体是 MRSA(37.5%),大多数患者为菌血症(60.0%)。DAP的中位剂量为8 [IQR,6-10] mg/kg,DAP治疗的中位持续时间为11.5 [IQR,4.8-18.8] 天。大多数患者取得了综合临床成功(75.0%)。5.0%的患者出现了不良反应。处方 DAP 最多的原因是其易于使用/便于出院(40.0%)和/或替代疗法存在问题(37.5%)。结论:大多数接受 DAP 治疗的儿科患者都取得了临床成功,不良反应发生率较低。有必要对 DAP 的使用情况进行更大规模的实际研究,以进一步评估临床效果。
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Real-World Clinical Characteristics and Outcomes with Daptomycin Use in Pediatric Patients: A Retrospective Case Series
Introduction: Daptomycin (DAP) is a cyclic lipopeptide that exhibits potent in vitro activity against many drug-resistant gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Despite substantial reports evaluating the clinical outcomes of DAP within the adult population, real-world data are lacking in children. The primary goal of this evaluation was to describe the clinical characteristics and outcomes of DAP use in pediatric patients across a wide range of infections. Methods: This retrospective evaluation included patients < 18 years of age who were treated with DAP from January 2014 to May 2023. The primary objective was to evaluate the composite clinical success, which was defined as a 30-day survival, the lack of a 30-day microbiological recurrence, and the resolution of signs and symptoms of an acute infection without therapy modifications based on clinical failures. Secondary objectives included adverse effects potentially attributable to DAP and reasons for DAP utilization. Results: Forty patients were included, which were predominately male (62.5%) and white (52.5%), with a median age of 8.7 [IQR, 4.4–16.0] years. DAP was used for a wide range of infections, including central line-associated bloodstream infections (CLABSIs; 32.5%), infective endocarditis (15.0%), surgical-site infections (12.5%), and osteomyelitis (12.5%). The most common pathogen isolated was MRSA (37.5%), and most patients were bacteremic (60.0%). The median DAP dose was 8 [IQR, 6–10] mg/kg, and the median duration of the DAP therapy was 11.5 [IQR, 4.8–18.8] days. Most patients achieved composite clinical success (75.0%). An adverse effect occurred in 5.0% of the patients. DAP was prescribed the most for its ease of use/ability to facilitate discharge (40.0%) and/or for issues with alternative therapies (37.5%). Conclusion: Most pediatric patients that received DAP demonstrated clinical success with a low incidence of adverse effects. Larger, real-world studies of DAP use are necessary to further assess clinical outcomes.
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