Daptomicina en el tratamiento de las infecciones por grampositivos en pacientes con insuficiencia renal crónica

The Use of Daptomycin to Treat Methicillin-Resistant Staphylococcus Epidermidis Bacteremia in a Critically Ill Child with Renal Failure

Daptomycin is excreted primarily unchanged by the kidney. Dosage regimens in children with renal failure remain to be determined. We report the case of an 8-year-old child with multiorgan failure undergoing continuous peritoneal dialysis, successfully treated with intravenous daptomycin for methicillin-resistant Staphylococcus epidermidis bacteremia. A dosage of 8 mg/kg every 48 hour was used. Plasma peak and trough concentrations of daptomycin were 68 mg/L and 14.6 mg/L, respectively, on day 6 of treatment. The dosage regimen achieved daptomycin exposure comparable to that reported in adults undergoing continuous ambulatory peritoneal dialysis and receiving recommended dosages.

Left-sided infective endocarditis in patients with liver cirrhosis

OBJECTIVE

To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery.

METHODS

Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.

RESULTS

A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery.

CONCLUSIONS

Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.