Daptomycin in the treatment of invasive Gram-positive bacterial infections in children: personal experience

Abstract

Aim: The emergence and dissemination of antimicrobial resistance among Gram-positive pathogens has become troublesome for pediatric patients. Daptomycin is a first-in-its-class cyclic lipopeptide, which can be useful for treatment of these infections in children, but clinical experience is lacking.

Methods: Retrospective review of medical records of seven hospitalized children who received daptomycin for treatment of invasive Gram-positive bacterial infections at Children's Cardiosurgery of AORNAS Civico-Di Cristina-Benfratelli, Palermo (Italy), from December 2009 to September 2010. Six patients had a congenital cardiomyopathy; only one patient had not any underlying comorbid condition. Bacterial isolates were tested for susceptibility to daptomycin by gradient diffusion method (E-test, Biomerieux).

Results: Seven children received daptomycin. All these children had invasive disease and only one of them was not receiving care in our Intensive Care Unit. Organisms isolated were 2 S. aureus methicillin-resistant; 4 S. Epidermidis methicillin-resistant and 1 E. faecium. Six infections were bloodstream infections and one was a complicated skin and soft tissue infection. All these infections had failed standard empirical antimicrobial therapy and had persistently positive blood cultures and/or fever prior to initiation of daptomycin. Outcomes after the initiation of daptomycin included clearance of blood cultures and defervescence within 72 hours. No drug related adverse events were documented.

Conclusion: All our patients improved but two patients died of complications of their pre-existing pathology. Further studies are necessary to assess the pharmacological characteristics, safety and effectiveness of daptomycin in children, but it seems to be promising antimicrobial agent in pediatric patients.