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Rapid Aggravation of Rhabdomyolysis Caused by Daptomycin After Aortic Arch Replacement: A Case Report
Kenichi Takechi1, Mayuko Fujimoto1, Tomoko Abe1
1Department of Anesthesia, Matsuyama Red Cross Hospital, Matsuyama, JPN.
Abstract:
Although rare, rhabdomyolysis is a serious complication of cardiothoracic surgery. Daptomycin is a polypeptide antimicrobial agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections of the soft tissues. Daptomycin is associated with elevations in serum creatine kinase (CK). A 50-year-old man with acute Stanford A-type aortic dissection was performed Bentall procedure and total arch replacement with frozen elephant trunk. The CK level was 6,573 U/L on the first postoperative day (POD), suggesting rhabdomyolysis associated with lower limb ischemia. The CK level increased to 11,934 U/L on POD 2 and started to decrease thereafter. On POD 5, the patient had a suspected surgical site infection. Antibiotics were changed to empiric therapy of daptomycin and meropenem to address soft tissue MRSA infection. The CK level at the start of daptomycin administration was 4,122 U/L. However, the CK level rose to 21,813 U/L on POD 6. None of the findings suggested new-onset lower limb ischemia. Assuming that the rhabdomyolysis was induced by daptomycin, it was discontinued. The CK level peaked at 26,123 U/L on POD 8, after which it started to decrease and normalized on POD 16. Daptomycin should be used with extreme caution in patients recovering from rhabdomyolysis.
Insights
Rhabdomyolysis, a rare but serious complication of cardiothoracic surgery, can be exacerbated by daptomycin. This case highlights the need for caution when using daptomycin in patients with elevated creatine kinase levels.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Rhabdomyolysis is a rare but severe complication following cardiothoracic surgery.
- Daptomycin is an antibiotic used for methicillin-resistant Staphylococcus aureus (MRSA) infections, known to cause elevated creatine kinase (CK).
Observation:
- A patient undergoing complex aortic repair developed rhabdomyolysis post-surgery.
- Following initial improvement, empiric daptomycin was initiated for a suspected MRSA surgical site infection.
- A significant increase in CK levels was observed after starting daptomycin, without evidence of recurrent ischemia.
Findings:
- The patient's rhabdomyolysis, indicated by markedly elevated CK levels, worsened after daptomycin initiation.
- Discontinuation of daptomycin led to a decrease in CK levels, suggesting a drug-induced effect.
- The case indicates a potential link between daptomycin and exacerbation of rhabdomyolysis in post-surgical patients.
Implications:
- Daptomycin use requires extreme caution in patients with or recovering from rhabdomyolysis, especially after cardiothoracic procedures.
- Monitoring CK levels closely during daptomycin therapy in this population is crucial.
- Further investigation into the mechanism of daptomycin-induced rhabdomyolysis is warranted.
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