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Las infecciones causadas por grampositivos son en la actualidad un problema terapéutico debido a la aparición y la diseminación de cepas con resistencia múltiple a los antibióticos utilizados como primera elección. Los glucopéptidos, considerados como fármacos alternativos, tienen una eficacia limitada para el tratamiento de las infecciones graves causadas por estos microorganismos, incluidas las bacteriemias y las infecciones endovasculares. Entre los nuevos antimicrobianos aprobados recientemente para su uso terapéutico, la daptomicina ofrece un perfil de eficacia clínica superior a linezolid y tigeciclina para el tratamiento de este tipo de infecciones. Su actividad bactericida y su potencial sinérgico con otros antibióticos, betalactámicos, rifampicina o aminoglucósidos, la sitúan entre los tratamientos de elección para las infecciones causadas por estafilococos y enterococos con resistencia múltiple a los antibióticos. La daptomicina ofrece, además, un excelente perfil de seguridad y una tasa muy reducida de resistencias. Se necesitan nuevos estudios en los que se incluya a numerosos pacientes con bacteriemia e infecciones endovasculares para establecer con precisión la eficacia clínica de estos fármacos. Los nuevos antimicrobianos, actualmente en desarrollo, presentan unas características similares a las de los glucopéptidos, con la excepción del ceftobiprole, y por ello su papel en el tratamiento de las infecciones graves por grampositivos multirresistentes aún está por determinar.
Palabras clave:
Bacteriemia
Endocarditis infecciosa
Tratamiento antimicrobiano
Nuevos antibióticos
Gram-positive infections currently constitute a therapeutic problem, caused by the emergence and spread of strains with multiple resistance to the antibiotics used as the first-line therapeutic option. Glycopeptides, considered as alternative drugs, have limited effectiveness in the treatment of severe infections, including bacteremias or vascular infections. Among the new antimicrobial agents recently licensed for use in humans, daptomycin offers a clinical efficacy profile superior to those of linezolid or tigecycline for the treatment of this type of infection. Because of its bactericidal activity and synergistic action with other antimicrobial agents, such a beta-lactams, rifampicin or aminoglycosides, daptomycin is a potential first-line therapeutic option for infections caused by multiresistant Gram-positive organisms. Moreover, daptomycin has an excellent safety profile, and the frequency of resistance is very low. New clinical trials including a substantial number of patients with bacteremia and vascular infections are needed to establish the potential clinical efficacy of these new antimicrobial agents. Antimicrobial agents currently in development have similar characteristics to those of glycopeptides, with the exception of ceftobiprole. Consequently, their role in the treatment of severe multiresistant Gram-positive infections remains to be determined.
Key words:
Bacteremia
Infective endocarditis
Antimicrobial therapy
New antibiotics
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