Daptomicina para el tratamiento de las infecciones por microorganismos grampositivos en el paciente crítico
Daptomycin for the treatment of Gram-positive microorganisms in the critically-ill patient
Francisco Álvarez-Lerma
, María Pilar Gracia-Arnillas
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Servicio de Medicina Intensiva, Hospital del Mar, Parc Salut Mar, Barcelona, España
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Su tratamiento ha experimentado cambios en los últimos años en relación con el mayor conocimiento de las limitaciones de los glucopéptidos y la aparición de nuevos antimicrobianos entre los que destaca la daptomicina.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir las características de la daptomicina que justifican su empleo en pacientes críticos y presentar la información sobre la utilización de este antibiótico en pacientes ingresados en UCI españolas.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se ha revisado la literatura científica de daptomicina para identificar las características que pueden favorecer la respuesta clínica en pacientes críticos. Para describir las indicaciones y las formas de uso de daptomicina en pacientes críticos, se ha analizado a los pacientes españoles ingresados en UCI del registro EUCORE.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se han identificado como condiciones favorables: <span class="elsevierStyleItalic">a)</span> escasa respuesta sistémica manteniendo una elevada actividad bactericida, <span class="elsevierStyleItalic">b)</span> escaso impacto en la función renal, <span class="elsevierStyleItalic">c)</span> no precisar de monitorización plasmática, <span class="elsevierStyleItalic">d)</span> escasa selección de resistencias, y e) excelente tolerabilidad. Para valorar las indicaciones y la forma de uso en la UCI como se ha analizado a 122 pacientes del registro EUCORE. Indicaciones: bacteriemias (36,2%), infecciones complicadas de piel y partes blandas (27,6%) y endocarditis (19%). En las etiologías han predominado <span class="elsevierStyleItalic">Staphylococcus aureus</span> (26%), <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> (25%) y otras especies de estafilococos coagulasa negativa (SCN) (12%). El tratamiento se ha administrado en el 85,7% de los casos en segunda línea (tratamiento de rescate). En 65 (52%) pacientes se utilizó una dosis de 6<span class="elsevierStyleHsp" style=""></span>mg/kg/día; la duración media de los tratamientos fue de 10,2 días. La eficacia clínica global fue del 73,7%. No se detectaron efectos adversos que obligaran a su retirada y en ningún caso se observó un incremento de la cifra de creatincinasa superior a 10 veces los valores iniciales.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Daptomicina es una nueva opción terapéutica que se debe considerar en el tratamiento de infecciones graves por CGP en pacientes críticos.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Infections caused by multiresistant Gram-positive cocci have increased among critically ill patients admitted to the intensive care unit (ICU). In the last few years, treatment of these infections has changed due to better knowledge of the limitations of glycopeptides and the introduction of novel antimicrobials, such as daptomycin.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of daptomycin that justify its administration in critically ill patients and to present data on the use of this antibiotic in patients admitted to Spanish ICUs.</p> <span class="elsevierStyleSectionTitle">Material and method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We reviewed the literature on daptomycin to identify the characteristics that may favor clinical response in critically ill patients. To describe the indications and modalities of use in critically patients, information from the European Cubicin<span class="elsevierStyleSup">®</span> Outcome Registry and Experience (EUCORE) database of Spanish patients admitted to the ICU was employed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The following favorable conditions were identified: <span class="elsevierStyleItalic">a)</span> scarce systemic response, maintaining high bactericidal activity, <span class="elsevierStyleItalic">b)</span> scarce impact on renal function, <span class="elsevierStyleItalic">c)</span> no requirement for monitoring of plasma levels, d) scarce selection of resistance, and d) excellent tolerability. To assess indications and the use of this agent in the ICU, 122 patients from the EUCORE database were analyzed. The indications were bacteremias (36.2%), complicated infections of the skin and soft tissues (27.6%), and endocarditis (19%). Prominent pathogens were <span class="elsevierStyleItalic">Staphylococcus aureus</span> (26%), <span class="elsevierStyleItalic">S. epidermidis</span> (25%), and other coagulase-negative staphylococci (12%). In 85.7% of patients, treatment was administered as second-line (rescue treatment). In 65 patients (52%), a dose of 6<span class="elsevierStyleHsp" style=""></span>mg/kg/day was used, with a mean treatment duration of 10.2 days. Overall clinical efficacy was 73.7%. No adverse effects leading to treatment withdrawal were recorded and no increases in creatine phosphokinase (CPK) levels greater than 10-fold the initial values were observed.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Daptomycin is a novel therapeutic option to be considered in the treatment of severe infections caused by Gram-positive cocci in critically-ill patients.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Antimicrobial Resistance Surveillance System. EARSS 2007. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Diciembre | 1 | 0 | 1 |
| 2023 Mayo | 1 | 0 | 1 |
| 2023 Marzo | 1 | 0 | 1 |
| 2021 Julio | 34 | 0 | 34 |
| 2021 Febrero | 15 | 0 | 15 |
| 2020 Octubre | 1 | 0 | 1 |
| 2020 Enero | 1 | 2 | 3 |
| 2019 Mayo | 1 | 0 | 1 |
| 2018 Enero | 0 | 1 | 1 |
| 2017 Octubre | 9 | 7 | 16 |
| 2017 Septiembre | 9 | 15 | 24 |
| 2017 Agosto | 18 | 8 | 26 |
| 2017 Julio | 16 | 11 | 27 |
| 2017 Junio | 22 | 33 | 55 |
| 2017 Mayo | 31 | 16 | 47 |
| 2017 Abril | 22 | 16 | 38 |
| 2017 Marzo | 40 | 26 | 66 |
| 2017 Febrero | 24 | 20 | 44 |
| 2017 Enero | 18 | 7 | 25 |
| 2016 Diciembre | 25 | 14 | 39 |
| 2016 Noviembre | 48 | 9 | 57 |
| 2016 Octubre | 58 | 22 | 80 |
| 2016 Septiembre | 31 | 16 | 47 |
| 2016 Agosto | 19 | 14 | 33 |
| 2016 Julio | 16 | 4 | 20 |
| 2016 Junio | 21 | 15 | 36 |
| 2016 Mayo | 23 | 17 | 40 |
| 2016 Abril | 12 | 11 | 23 |
| 2016 Marzo | 12 | 9 | 21 |
| 2016 Febrero | 15 | 9 | 24 |
| 2016 Enero | 27 | 5 | 32 |
| 2015 Diciembre | 8 | 8 | 16 |
| 2015 Noviembre | 17 | 12 | 29 |
| 2015 Octubre | 22 | 8 | 30 |
| 2015 Septiembre | 16 | 8 | 24 |
| 2015 Agosto | 12 | 10 | 22 |
| 2015 Julio | 14 | 11 | 25 |
| 2015 Junio | 10 | 4 | 14 |
| 2015 Mayo | 16 | 13 | 29 |
| 2015 Abril | 12 | 12 | 24 |
| 2015 Marzo | 14 | 19 | 33 |
| 2015 Febrero | 16 | 7 | 23 |
| 2015 Enero | 31 | 4 | 35 |
| 2014 Diciembre | 32 | 4 | 36 |
| 2014 Noviembre | 28 | 3 | 31 |
| 2014 Octubre | 31 | 2 | 33 |
| 2014 Septiembre | 34 | 3 | 37 |
| 2014 Agosto | 27 | 1 | 28 |
| 2014 Julio | 38 | 1 | 39 |
| 2014 Junio | 36 | 2 | 38 |
| 2014 Mayo | 24 | 2 | 26 |
| 2014 Abril | 15 | 1 | 16 |
| 2014 Marzo | 32 | 1 | 33 |
| 2014 Febrero | 36 | 2 | 38 |
| 2014 Enero | 34 | 3 | 37 |
| 2013 Diciembre | 51 | 2 | 53 |
| 2010 Diciembre | 497 | 0 | 497 |
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