Daptomycin for multi-drug resistant gram (+) infections in heart surgery patients: a single centre experience

Objectives: Surgical infection remains a main cause of death after heart surgery, in spite of the advances in pharmacological therapy. Daptomycin (Dap) is a cyclic lipopeptide antibiotic, useful in gram(+) organisms resistant to standard treatment, including vancomycin. Our aim was to describe the use of Dap in patients with multi-drug resistant gram(+) infections after heart surgery. Methods: 50 consecutive patients presenting with resistant gram(+) infections after heart surgery and treated with Dap (loading dose 6mg/kg/d BW; maintenance 4mg/kg/d BW) were retrospectively studied. Demographics, surgical procedure, type of infection, responsible pathogen, outcome, and adverse events were analyzed. Results: 50 patients (44 males, 5 females; mean age 62±15 y) were studied; Procedure: CABG: 12%; HTX: 10%; VAD: 20%; combined procedures 20%, valve surgery: 10%; others: 28%), Type of infection: catheter-related infection: 45%, sternal wound infection: 20%, Pacemaker-wire infection: 5%, others 30%. The initial Dap dose was 6mg/kg, continued with 4mg/kg. Duration of treatment was 10.6±10d. Pathogens were MSSA 4%, MRSA 14%, S. epidermidis 35%, E. faecium 12%, others 13%, no pathogen found 22%. 88% of the patients showed clinical improvement, in 76% of the patients healing without residues could be achieved. No adverse events were reported. Conclusions: Daptomycin proved safe and effective in our patients. The most common indications were catheter-related infections and sternal wound infections. Prospective trials are mandatory to evaluate the role of Dap, especially in patients with sternal wound infection, caused by multi-drug resistant gram(+) pathogens.