Beta Lactams Plus Daptomycin Combination Therapy for Infective Endocarditis: An Italian National Survey (BADAS)
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Survey Design
4.2. Survey Administration
4.3. Response Rates
4.4. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Type of Hospital | University | Base Level | I Level | II Level |
---|---|---|---|---|
(Responding 54/55 partecipants) | 28 (51.85%) | 5 (9.26) | 16 (29.63) | 5 (9.26) |
Number of beds | <100 | 100–200 | 200–500 | >500 |
(Responding 55/55 partecipants) | 3 (5.45%) | 4 (7.27) | 20 (36.36) | 28 (50.91) |
Intensive Care Unit in-hospital | No | Yes | ||
(Responding 55/55 partecipants) | 2 (3.64%) | 53 (96.36) | ||
If YES category: | ||||
CCH/cardio; 16 (30.18) | ||||
NCH/neuro; 6 (11.32) | ||||
Burn; 1 (1.88) | ||||
Transplant; 5 (9.43) | ||||
Pediatric; 3 (5.66) | ||||
High Risk Unit in-hospital | No | Yes | ||
(Responding 54/55 partecipants) | 32 (59.26%) | 22 (40.74) | ||
If YES category: | ||||
Haematologic; 3 (5.56) | ||||
SOT; 7 (12.96) | ||||
Pediatric; 1 (1.85) | ||||
NCH; 1 (1.85) | ||||
CCH; 10 (18.52) |
ID Consultant | In-Hospital | In-Hospital with ID Unit | On-Call | No ID |
---|---|---|---|---|
(Responding 54/55 partecipants) | 16 (29.63%) | 36 (66.67) | 1 (1.85) | 1 (1.85) |
Infection Comitee in the Hospital | No | Yes | ||
(Responding 54/55 partecipants) | 1 (1.85%) | 53 (98.15) | ||
Alert systems for MDROs | No | Yes | ||
(Responding 54/55 partecipants) | 42 (77.78%) | 12 (22.22) | ||
Available epidemiological MDRO’s data | No | Yes | ||
(Responding 54/55 partecipants) | 2 (3.70%) | 54 (96.3) | ||
Presence of antibiotic GL | No | Yes | Regional GL | Hospital GL |
(Responding 54/55 partecipants) | 19 (35.19%) | 35 (64.81) | 10 (28.57) | 25 (71.43) |
IE Per Years | >50 Years | <50 Years | |
(Responding 53/55 partecipants) | 14 (26.42%) | 39 (73.58) | |
Presence of Endocarditis Team | No | Yes | |
(Responding 53/55 partecipants) | 37 (69.81%) | 16 (30.19) | |
Presence of CCH | No | Yes | |
(Responding 54/55 partecipants) | 22 (40.74%) | 32 (59.26) | |
Prescription of ABX in IE | ID | Physician | Both |
(Responding 53/55 partecipants) | 34 (62.97%) | 1 (1.85) | 18 (33.33) |
Empiric ABX in IE Native Valve | Combination | Monotherapy | |
Total | 42 (77.77%) | 12 (22.22) | |
Including always Vancomycin | 3 (5.55%) | ||
Including always AG | 1 (1.88%) | ||
Empiric ABX in IE Protesic Valve | Combination | Monotherapy | |
Total | 45 (83.33%) | 1 (1.85) | |
Including always Vancomycin | 3 (5.88%) | ||
Including always AG | 2 (3.92%) | ||
Duration of treatment (No need for CCH) | <6 wks (according to isolated) | >6 wks (indipendent to isolated) | |
(Responding 54/55 partecipants) | 45 (83.33%) | 9 (16.67) | |
Duration of treatment (Need for CCH) | <6 wks (according to isolated) | >6 wks (indipendent to isolated) | |
(Responding 54/55 partecipants) | 45 (83.33%) | 9 (16.67) | |
Duration of treatment | IE Native Valve | IE Protesic Valve | |
Median (IQR) | 4 (2–89) wks | 6 (4–12) |
Empiric Daptomycin in IE | IE MRSA | IE MSSA | IE Enterococcus | IE Streptococcus |
(Responding 52/55 partecipants) | 47 (90.38) | 2 (3.85) | 3 (5.77) | 0 (0) |
Ongoing Resistant Streptococcus spp. strains to Daptomycin | No | Yes | ||
(Responding 52/55 partecipants) | 40 (76.92) | 12 (23.07) | ||
Monotherapy | 11 (91.66) | |||
Combination | 1 (8.34) | |||
Daptomycin in Clinical Practice in IE | First-line in Empiric Therapy | First-line in MRSA IE | No First-line | |
(Responding 53/55 partecipants) | 17 (31.48) | 24 (44.44) | 12 (24.07) | |
Daptomycin Empirical in IE (Native Valve) | ||||
High Clinical Efficacy | 10 (18.87) | |||
Combination with AG-sparing | 13 (24.53) | |||
High penetration in vegetations | 6 (11.32) | |||
Safety and low toxicity | 3 (5.66) | |||
Single-day administration and OPAT choice | 3 (5.66) | |||
Biofilm acitivity | 5 (9.43) | |||
High bacterial killing rate | 13 (24.53) | |||
Low rate of resistant strains/favourable MICs | 0 (0) | |||
Daptomycin Empirical in IE (Prostethic Valve) | ||||
High Clinical Efficacy | 5 (9.80) | |||
Combination with AG-sparing | 5 (9.80) | |||
High penetration in vegetations | 4 (7.84) | |||
Safety and low toxicity | 5 (9.80) | |||
Single-day administration and OPAT choice | 1 (1.96) | |||
Biofilm acitivity | 29 (56.86) | |||
High bacterial killing rate | 2 (3.92) | |||
Low rate of resistant strains/favourable MICs | 0 (0) | |||
Methods of Daptomycin Using in IE | ||||
(≤6 mg/kg) Monotherapy | 0 (0) | |||
(≤6 mg/kg) Combination | 4 (7.41) | |||
(8-10 mg/kg) Monotherapy | 12 (22.22) | |||
(8-10 mg/kg) Combination | 38 (70.37) | |||
Daptomycin in combination therapy in IE | ||||
Rifampin | 5 (10.42) | |||
AG | 4 (8.33) | |||
Beta-lactams | 26 (54.17) | |||
Cephalosporins (III or IV gen) | 4 (8.33) | |||
Novel Cephalosporins | 9 (18.75) | |||
Daptomycin dose in clinical practice in IE according to pathogen | ||||
Streptococcus spp. | 0 (0) | |||
MSSA | 0 (0) | |||
MRSA | 33 (61.11) | |||
Both MRSA and MSSA | 9 (16.67) | |||
Enterococcus spp. | 4 (7.41) | |||
Indipendently to pathogens | 8 (14.81) | |||
Daptomycin plus Beta-lactams in IE | ||||
Streptococcus spp. | 0 (0) | |||
MSSA | 2 (3.70) | |||
MRSA | 25 (46.30) | |||
Both MRSA and MSSA | 10 (18.52) | |||
Enterococcus spp. | 10 (18.52) | |||
Indipendently to pathogens | 7 (12.96) | |||
Daptomycin plus Beta-lactams in IE (regimens) | ||||
Empiric therapy | 9 (16.98) | |||
Targeted plus OPAT | 14 (26.42) | |||
Targeted then oral de-escalation | 19 (35.85) | |||
Targeted in-hospital (no OPAT) | 11 (20.75) | |||
De-escalation after Daptomycin therapy in IE (stable/operated) | ||||
After 1–2 wks | 22 (40.00) | |||
After 3 wks | 18 (32.73) | |||
After 6 wks | 3 (5.45) | |||
De-escalation is not common in our centre | 12 (21.82) | |||
Choices for De-escalation after Daptomycin in IE | ||||
MSSA | Beta-lactams, cephalosporins, TMP/SMX, clyndamicin, doxicycline, doxicycline, rifampicin and fluoroquinolones | |||
MRSA | TMP/SMX, dalbavancin, linezolid, doxicycline and rifampicin | |||
Daptomycin interruption or substitution | ||||
Partial or no response | 1 (1.85) | |||
Adverse effects | 7 (12.96) | |||
Costs | 3 (5.56) | |||
Medications more accessible in OPAT or long-term facility | 23 (42.59) | |||
De-escalation | 20 (37.04) |
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Corcione, S.; Lupia, T.; Pallotto, C.; Giacobbe, D.R.; De Benedetto, I.; Stroffolini, G.; Mornese Pinna, S.; Tascini, C.; Bassetti, M.; De Rosa, F.G.; et al. Beta Lactams Plus Daptomycin Combination Therapy for Infective Endocarditis: An Italian National Survey (BADAS). Antibiotics 2022, 11, 56. https://doi.org/10.3390/antibiotics11010056
Corcione S, Lupia T, Pallotto C, Giacobbe DR, De Benedetto I, Stroffolini G, Mornese Pinna S, Tascini C, Bassetti M, De Rosa FG, et al. Beta Lactams Plus Daptomycin Combination Therapy for Infective Endocarditis: An Italian National Survey (BADAS). Antibiotics. 2022; 11(1):56. https://doi.org/10.3390/antibiotics11010056
Chicago/Turabian StyleCorcione, Silvia, Tommaso Lupia, Carlo Pallotto, Daniele Roberto Giacobbe, Ilaria De Benedetto, Giacomo Stroffolini, Simone Mornese Pinna, Carlo Tascini, Matteo Bassetti, Francesco Giuseppe De Rosa, and et al. 2022. "Beta Lactams Plus Daptomycin Combination Therapy for Infective Endocarditis: An Italian National Survey (BADAS)" Antibiotics 11, no. 1: 56. https://doi.org/10.3390/antibiotics11010056