[Treatment of multiresistant Gram positive endocarditis]

Area of Science:

• Infectious Diseases
• Microbiology
• Pharmacology

Context:

• Infectious endocarditis epidemiology has shifted towards hospital-acquired infections.
• Multidrug-resistant pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA), are increasingly implicated.
• Reduced vancomycin susceptibility (h-VISA) in MRSA strains poses a therapeutic challenge.

Purpose:

• To evaluate the efficacy of daptomycin in treating staphylococcal endocarditis.
• To compare daptomycin's effectiveness against methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) strains, including h-VISA.
• To assess daptomycin's role as an initial therapy versus rescue therapy.

Summary:

• Daptomycin demonstrates rapid bactericidal activity against MSSA and MRSA, including h-VISA strains.
• Clinical efficacy rates for daptomycin in staphylococcal endocarditis are high (MRSA 71%, MSSA 75%).
• While reduced efficacy after vancomycin failure is theoretically possible due to cell wall changes, it's rare in practice; initial daptomycin therapy is preferred.

Impact:

• Supports daptomycin as a first-line treatment for staphylococcal endocarditis, irrespective of methicillin susceptibility.
• Highlights daptomycin's good tolerability at higher dosages (8-10 mg/kg/day) with necessary CPK monitoring.
• Suggests daptomycin as a potential alternative for vancomycin-resistant enterococcal endocarditis, alone or in combination therapy.