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Resumen
La infección por grampositivos resistentes (GPR) es muy prevalente, sobre todo en el medio hospitalario. El incremento en el uso de glucopéptidos tiene un coste microbiológico: cepas resistentes a vancomicina (escasas), cepas con sensibilidad intermedia, heterorresistencia o tolerancia a glucopéptidos, y cepas sensibles a glucopéptidos pero con mayores concentraciones mínimas inhibitorias, que obligan a aumentar la dosis de vancomicina y su toxicidad. Con la inclusión de linezolid y gracias a su perfil farmacodinámico se han podido tratar con más eficacia infecciones localizadas por GPR en áreas de difusión compleja o tejidos isquémicos, a un escaso coste microbiológico en selección de cepas resistentes. Algo parecido ha sucedido con tigeciclina; su amplio espectro le ha permitido el tratamiento de infecciones complejas mixtas por patógenos resistentes. Sin embargo, su condición de antibióticos bacteriostáticos limita a ambos en el manejo inicial de la bacteriemia, la endocarditis o la infección en huésped inmunocomprometido. Daptomicina constituye una alternativa eficaz frente a estas infecciones graves por GPR, por su alto poder bactericida precoz y por no afectarse por estos fenómenos de heterorresistencia y tolerancia.
Palabras clave:
Daptomicina
Vancomicina
Heterorresistencia
Bacteriemia
Endocarditis
Registro CORE
Staphylococcus aureus
Abstract
Infection by antimicrobial-resistant Gram-positive bacteria (GPB) is highly prevalent, especially in the hospital setting. The increase in the use of glycopeptides has a microbiological cost: vancomycin-resistant strains (scarce), strains with intermediate sensitivity, heteroresistant and glycopeptide-tolerant strains and glycopeptide-sensitive strains but with a higher minimal inhibitory concentration require a higher dose of vancomycin, increasing toxicity. Because of its pharmacodynamics profile, linezolide has allowed more effective treatment of localized GPB infections in areas with complex spread and in ischemic tissues with little cost in terms of the selection of resistant strains. Similarly, because of its broad spectrum, tigecycline can be used to treat complex mixed infections caused by resistant pathogens. However, because linezolide and tigecycline are bacteriostatic agents, their use in the initial management of bacteremia, endocarditis and infection in immunocompromised hosts is limited. Because daptomycin has potent early bactericidal activity and has not been affected by heteroresistance or tolerance, this drug is an effective alternative against these severe GPB infections.
Keywords:
Daptomycin
Vancomycin
Heteroresistance
Bacteremia
Endocarditis
CORE registry
Staphylococcus aureus
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