[Show abstract][Hide abstract] ABSTRACT: Antibiotic resistance, a major public health problem, has been linked to antibiotic consumption. In Greece both consumption and resistance rates are among the highest in Europe. A multifaceted campaign targeting both physicians and parents of school children was implemented for the first time in order to educate the public and update doctors, aiming to promote judicious use of antibiotics and hopefully decrease its consumption.
The programme consisted of a public education campaign and academic detailing of primary care physicians in the district of Corinth in Peloponnese. The experience and perceptions of parents were recorded in the meetings in the form of course evaluation and assessment, anonymous questionnaires. The use of Rapid Antigen Detection Test (RADT) for streptococcal pharyngitis by primary care physicians was also assessed by use of anonymous questionnaires. Antibiotic consumption was compared before and after the programme between the district of Corinth and the other districts of Peloponnese, as well as at a national level.
Antibiotic consumption remained unaltered at 26 Defined daily doses per 1000 Inhabitants per Day (DID) in accordance with the trend in other regions and at a national level. However, the utilization of Amoxycillin and Penicillin was increased by 34.3%, while the use of other antimicrobial classes including macrolides, cephalosporins and fluoroquinolones decreased by 6.4-21.9%. The use of RADT did not lead to a significantly decreased antimicrobial consumption.
A multifaceted educational programme targeting both the general public and primary care physicians was associated with rationalization in the choice of antimicrobial. A reduction in the total antimicrobial consumption was not achieved.
Full-text · Article · Aug 2014 · BMC Public Health
[Show abstract][Hide abstract] ABSTRACT: Background: Osteomyelitis is a difficult to treat infection especially in the antibiotic resistance era. Antibiotics’ local elution systems have been developed to combat osteomyelitis . We describe local elution of linezolid by cancellous bone. Methods: Particles of cancellous bone provided during operation for elective hip arthroplasty were mechanically homogenized then sterilized and compressed into wire-mesh cylinders where they were impregnated into a solution of linezolid 3mg/ml for 1, 24 and 48 hours. Consequently all impregnated cylinders were immersed into muller-hinton broth and were incubated for 24 hours. Then supernatants were kept in-70oC. This procedure was repeated every 24 hours for 4 consecutive days. Linezolid concentration in all supernatants was measured by HPLC methodology. Every experiment was done in dublicate. Results: Linezolid elution was expressed in table; peak concentrations for1, 24 and 48 hours impregnation with linezolid were found on day 1 while after day 4 no elution was detected.
Linezolid mean concentrations + SE ( μg/ml) Day 1 Day2 Day3 Day4
Control bone 0 0 0 0
Bone impregnated 1hour 63.81 + 2.85 5.80 + 0.36 0.58 + 0.18 0.12 + 0.07
Bone impregnated 24hours 80.00 + 9.00 9.43 + 0.82 1.13 + 0.44 0.15 + 0.03
Bone impregnated 48 hours 72.72 + 2.27 8.93 + 0.35 1.98 + 0.17 0.44 + 0.11
Conclusion: Linezolid reached a peak of release on day 1 and then a reduced elution after day 2. Highest concentrations detected in subjects impregnated for at least 24h. were multi-fold the MICs values of standard Gram positive bacteria (MRSA, MSSA,MRSE, Enterococci). These results make linezolid from a cancellous bone delivery system a candidate agent for chemoprophylaxis from Gram positive bacteria in elective surgery for hip arthroplasty .
[Show abstract][Hide abstract] ABSTRACT: Background:
To evaluate the impact of an antibiotic restriction policy on antibiotic consumption and Gram-negative resistance rates, in an environment of antibiotic overconsumption and increasing resistance rates for nosocomial pathogens.
The study was a 'before and after' trial of 18-month duration; the antibiotic restriction policy program was implemented in 1998-2000 and was based on a government program addressed by the Ministry of Health to public hospitals on a national basis. This included prescribing of all newer antibiotics on an order form, auditing of the order forms and consultation with infectious diseases (ID) specialists, dispensing of treatment and prophylaxis guidelines, feedback, and face-to-face education. Antibiotic consumption and Gram-negative resistance rates were recorded before and after the intervention.
Despite the addition of a new 40-bed ID department in the hospital during the 'after' period, the consumption of restricted antibiotics was significantly reduced by 42% (and their cost by 31%). Gram-negative resistance rates for Pseudomonas, Klebsiella, and Enterobacter, serving as index microorganisms for Gram-negative nosocomial pathogens, were significantly reduced during the 'after' period, even against antibiotics for which there was an increase in consumption.
Multidisciplinary restriction programs can reduce antibiotic consumption and Gram-negative resistance rates in the hospital setting.
No preview · Article · Jan 2013 · Scandinavian Journal of Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Clin Microbiol Infect 2012; 18: E52–E54
16S ribosomal RNA methylase-mediated high-level resistance to 4-,6-aminoglycosides has been reported in clinical isolates of gram-negative bacilli from several countries. Three of 1534 (0.2%) isolates of Klebsiella pneumoniae and three of 734 (0.4%) Proteus mirabilis isolates from a university hospital in Athens, Greece, were positive for rmtB and highly resistant to all aminoglycosides tested (MICs ≥256 mg/L). Two of the K. pneumoniae rmtB-bearing isolates, were KPC-2 and OXA-10 producers and the third was a DHA-1 producer. One of the P. mirabilis isolates was a VIM-1 and OXA-10 producer and one was an OXA-10 producer. All rmtB-harbouring isolates were clonally unrelated. None of the E. coli (n = 1398) and Enterobacter spp. (n = 414) isolates were positive for armA, rmtA, rmtB, rmtC or rmtD.
Full-text · Article · Mar 2012 · Clinical Microbiology and Infection
[Show abstract][Hide abstract] ABSTRACT: Background: Vertebral brucellar spondylitis is a significant complication of brucellosis bearing diagnostic and therapeutic challenges. Treatment modalities of prospectively collected data from a University Department were analyzed as optimal regimen and treatment duration has not been established yet.
Methods: Demographics, comorbidities, rural residency, risk factors, duration of the disease, prior therapies, complications and relapses were assessed. Safety and efficacy of two treatment modalities, the backbone treatment (doxycycline plus rifampicin) plus either cotrimoxazole (DRC) or ofloxacin(DRO) as a third therapeutic agent, were analyzed. Clinical, laboratory and MRI imaging criteria defined the end of therapy. A regression analysis of factors influencing the disease’s outcome was preformed. Standard clinical, laboratory microbiology and imaging case definition were applied.
Results: Eligible patients (n=31) were male (58%), elderly with a median age + IQR (25-75) of 63(51.5- 68) years with comorbidities (58%), risk factors for brucellosis (71%) and rural residency (80.6%). Median time from the onset of symptoms was 12 months (range 4-20) with a 48.3% rate of previous unsuccessful treatment. Spinal pain was initially underestimated in 53% of patients. Paravertebral lesions (n=12) were significantly associated with residual pain (OR = 20.3, CI 95% 1.9-218.2, p=0.01) in a post-treatment follow-up of median+IQR(25-75) of 52(21.2-84) months.
No difference regarding demographics, clinical features, treatment duration [median+ IQR(25-75) 8(6-12) months] and final outcome was found between DRC and DRO group. Reversible adverse events were detected in 6 patients. No surgical intervention was needed.
Conclusion: We recommend the triple combination ( DRC or DRO) for a prolonged period ( at least 3 months) for cases of initial treatment failure or relapsing vertebral brucellosis. Paravertebral lesions even not requiring surgery are associated with residual back pain despite successful treatment of brucellosis.
[Show abstract][Hide abstract] ABSTRACT: Using time-kill methodology, we investigated the interactions of fosfomycin with meropenem or colistin or gentamicin against
17 genetically distinct Klebsiella pneumoniae clinical isolates carrying blaKPC-2. Synergy was observed with meropenem or colistin against 64.7 and 11.8% of tested isolates, while the combination with gentamicin
resulted in indifference. All studied combinations showed improved bactericidal activity, compared to fosfomycin alone and
prevented the development of fosfomycin resistance in 69.2, 53.8, and 81.8% of susceptible isolates, respectively.
Full-text · Article · Feb 2011 · Antimicrobial Agents and Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.
Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.
One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004-July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p=0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p=0.004), membrane rupture for more than 6 hours (p=0.08) and blood loss greater than 500 ml (p=0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p=0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p=0.004).
Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.
Clinicaltrials.gov identifier: NCT01138852.
Full-text · Article · Nov 2010 · BMC Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND. The Toll-like receptor 4 (TLR4) is an essential component of the innate immune response to various microorganisms. We investigated the association between TLR4 polymorphism and the risk of acquiring severe infections, in patients with human immunodeficiency virus (HIV)-1 infection. METHODS. The presence of TLR4 Asp299Gly and Thr399Ile single nucleotide polymorphisms (SNPs) was determined in a cohort of 199 HIV-1 infected patients and evaluated in relation to the occurrence of various infections. RESULTS. One hundred seventy-two patients were homozygous for the wild-type genotype; 22 patients (11%) were heterozygous for both SNPs; 4 were heterozygous for 1 polymorphism; 1 patient was heterozygous for the Asp299Gly SNP and homozygous for the Thr399Ile SNP. Of individuals with a nadir CD4 cell count of <100 cells/mm(3), those who carried both SNPs, compared with those who carried the wild-type genotype, demonstrated a >3-fold increase in the odds ratio (OR) of any serious infection (OR, 6.33 vs OR, 1.83, P = .043). CONCLUSIONS. This study suggests an association between the presence of TLR4 Asp299Gly and Thr399Ile polymorphisms and the occurrence of serious infections in HIV-1 infected patients with a history of nadir CD4 cell count of <100 cells/mm(3).
[Show abstract][Hide abstract] ABSTRACT: Although major changes of the immune system have been described in sepsis, it has never been studied whether these may differ in relation to the type of underlying infection or not. This was studied for the first time.
The statuses of the innate and adaptive immune systems were prospectively compared in 505 patients. Whole blood was sampled within less than 24 hours of advent of sepsis; white blood cells were stained with monoclonal antibodies and analyzed though a flow cytometer.
Expression of HLA-DR was significantly decreased among patients with severe sepsis/shock due to acute pyelonephritis and intraabdominal infections compared with sepsis. The rate of apoptosis of natural killer (NK) cells differed significantly among patients with severe sepsis/shock due to ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) compared with sepsis. The rate of apoptosis of NKT cells differed significantly among patients with severe sepsis/shock due to acute pyelonephritis, primary bacteremia and VAP/HAP compared with sepsis. Regarding adaptive immunity, absolute counts of CD4-lymphocytes were significantly decreased among patients with severe sepsis/shock due to community-acquired pneumonia (CAP) and intraabdominal infections compared with sepsis. Absolute counts of B-lymphocytes were significantly decreased among patients with severe sepsis/shock due to CAP compared with sepsis.
Major differences of the early statuses of the innate and adaptive immune systems exist between sepsis and severe sepsis/shock in relation to the underlying type of infection. These results may have a major impact on therapeutics.
Full-text · Article · May 2010 · Critical care (London, England)
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to report the prevalence of episodes of DSM-IV major depression, as well as their identification rates, in elderly inpatients in a general hospital in Greece.
200 selected patients, 65 years old and over, hospitalized in Surgery and Internal Medicine Departments, were assessed for major depression over a period of 12 months (October 2006-November 2007) by means of SCID-I/P, HADS, BDI and GDS-15. During the same period, liaison calls from the same departments were evaluated and findings were compared.
When psychiatric screening was performed, 28 patients (14%) were diagnosed as suffering from a major depressive episode. During the same period, there were only 20 liaison calls from the same departments for patients over 65 years old, from which 4 patients were found to be suffering from major depression. Comparison between the two periods showed significant underestimation of depression. All psychometric scales detected depression sufficiently.
In general hospital elderly inpatients, depression still remains underestimated. Depression symptom scales could be used as routine tests for screening major depression.
No preview · Article · Apr 2010 · Aging clinical and experimental research
[Show abstract][Hide abstract] ABSTRACT: Antibiotic resistance has been associated with the use of antibiotics. The dispensing of antimicrobials without prescription is a potential source of inappropriate antibiotic use. In our study, antibiotics were requested without prescription from pharmacies in the metropolitan area of Athens in Greece in 2008. Twenty-one collaborators visited 174 pharmacies and asked for either amoxicillin/clavulanate acid or ciprofloxacin without providing a prescription or any other justification for the request. In Greece additional restrictions for fluoroquinolone prescriptions were implemented in 2003 after which a separate specific prescription form needs to be filled in by the prescriber, justifying the choice of any fluoroquinolone. Amoxicillin/clavulanate acid was dispensed in all cases. Furthermore, despite the regulation restricting the prescription of ciprofloxacin, this drug was dispensed by 53% of the pharmacies. It appears that the implementation of measures to restrict the use of certain antibiotics (e.g. ciprofloxacin that was studied in our case) was effective in reducing, although not eliminating, inappropriate dispensing. Overall, dispensing of antimicrobials without prescription is a widespread practice in the studied area and is contributing to the overuse of antibiotics.
Full-text · Article · Feb 2010 · Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin
[Show abstract][Hide abstract] ABSTRACT: We describe the emergence and spread of Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing K. pneumoniae at a Greek University hospital.
Isolates with a carbapenem minimum inhibitory concentration >1 microg/mL and a negative EDTA-imipenem disk synergy test result were submitted to boronic acid disk test and to polymerase chain reaction (PCR) for KPC gene and sequencing. Records from patients who had KPC-2-producing K. pneumoniae isolated were retrospectively reviewed. Clinical isolates were submitted to molecular typing using pulsed-field gel electrophoresis, and the beta-lactamase content was studied using isoelectric focusing and PCR.
From January 2007 through December 2008, 50 patients (34 in the intensive care unit [ICU]) were colonized (n = 32) or infected (n = 18) by KPC-2-producing K. pneumoniae. Increasing prevalence of KPC-2-producing K. pneumoniae coincided with decreasing prevalence of metallo-beta lactamase-producing isolates in our ICU. Multidrug resistance characterized the studied isolates, with colistin, gentamicin, and fosfomycin being the most active agents. Besides KPC-2, clinical isolates encoded TEM-1-like, SHV-11, SHV-12, CTX-M-15, and LEN-19 enzymes. Four different clonal types were detected; the predominant one comprised 41 single patient isolates (82%). Sporadic multiclonal cases of KPC-2-producing K. pneumoniae infection were identified from September 2007 through May 2008. The outbreak strain was introduced in February 2008 and disseminated rapidly by cross-transmission; 38 patients (76%) were identified after August 2008. Fourteen cases of bacteremia, 2 surgical site infections, 2 lower respiratory tract infections (1 bacteremic), and 1 urinary tract infection were identified. Most patients received a colistin-containing combination treatment. Crude mortality was 58.8% among ICU patients and 37.5% among non-ICU patients, but attributable mortality was 22.2% and 33.3%, respectively.
The emergence of KPC-2-producing K. pneumoniae in Greek hospitals creates an important challenge for clinicians and hospital epidemiologists, because it is added to the already high burden of antimicrobial resistance.
Full-text · Article · Feb 2010 · Clinical Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: We studied the effects of antimicrobial prophylaxis and possible predictors of failure in multiple sclerosis patients with bacteriuria and bladder dysfunction. patients were categorized into 3 groups, according to post-voided residual urine volume (PVR): patients with indications for self-intermittent catheterization (SIC) who elected (Group A, n=39) or not (Group B, n=53) to use SIC and patients with no indication for SIC (Group C, n=75). In group A, 90% of patients developed bacteriuria after SIC. Rates of bacteriuria in groups B and C were significantly lower (34% and 24%, respectively, all p<0.001). Prophylaxis failed in 31% and 22% of patients in groups A and b, respectively whereas all group C patients responded to prophylaxis. Symptomatic urinary tract infection was observed only in 14% of group A patients. Significant predictors of prophylaxis failure were an expanded disability status scale (EDSS) score >6 (p<0.05), a high pVR (p<0.075) and resistance to prophylaxis regimen (p<0.007). SIC did not have a significant association with prophylaxis failure. In multivariate analysis only a higher eDSS score (>6) predicted prophylaxis failure (p=0.019).
No preview · Article · Feb 2010 · Journal of chemotherapy (Florence, Italy)
[Show abstract][Hide abstract] ABSTRACT: The characteristics of cancellous bone allografts as carriers of moxifloxacin are described. Particles of cancellous bone were compressed into a wire-mesh cylinder and impregnated into a solution of moxifloxacin for different time periods. Five replicas were impregnated for 1 h; another five for 24 h; and another five for 48 h. Impregnated allografts were then transferred into vials containing 5 ml of Mueller-Hinton broth and incubated at 37 degrees C. Broth was replaced daily. Concentrations of moxifloxacin in broth were determined after analysis by an high performance liquid chromatography system. Moxifloxacin was eluted at very high concentrations within the first days. Concentrations remained above 100 microg/ml until day 8 and above 40 microg/ml until day 20. It is concluded that cancellous bone allografts may allow the adequate in vitro elution of moxifloxacin. The latter results support their application in experimental models of osteomyelitis.
No preview · Article · Jan 2010 · Journal of Biomedical Materials Research Part A
[Show abstract][Hide abstract] ABSTRACT: The pandemic by the novel H1N1 virus has created the need to study any probable effects of that infection in the immune system of the host.
Blood was sampled within the first two days of the presentation of signs of infection from 10 healthy volunteers; from 18 cases of flu-like syndrome; and from 31 cases of infection by H1N1 confirmed by reverse RT-PCR. Absolute counts of subtypes of monocytes and of lymphocytes were determined after staining with monoclonal antibodies and analysis by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from patients and stimulated with various bacterial stimuli. Concentrations of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-18, interferon (FN)-alpha and of IFN-gamma were estimated in supernatants by an enzyme immunoassay. Infection by H1N1 was accompanied by an increase of monocytes. PBMCs of patients evoked strong cytokine production after stimulation with most of bacterial stimuli. Defective cytokine responses were shown in response to stimulation with phytohemagglutin and with heat-killed Streptococcus pneumoniae. Adaptive immune responses of H1N1-infected patients were characterized by decreases of CD4-lymphocytes and of B-lymphocytes and by increase of T-regulatory lymphocytes (Tregs).
Infection by the H1N1 virus is accompanied by a characteristic impairment of the innate immune responses characterized by defective cytokine responses to S.pneumoniae. Alterations of the adaptive immune responses are predominated by increase of Tregs. These findings signify a predisposition for pneumococcal infections after infection by H1N1 influenza.
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to explore the epidemiological features and resistance rates in uropathogens isolated from cases of acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide empirical treatment. Urine samples from outpatients aged >16 years were cultured and for each uropathogen isolated non-susceptibility to orally administered antimicrobial agents was defined. Demographic and clinical data were provided in questionnaire form. From January 2005 to March 2006 a total of 1936 non-duplicate positive urinary cultures were collected and 889 AUC cases were evaluated. Escherichia coli was the main aetiological agent (83%). In the AUC group, non-susceptibility rates for E. coli isolates were as follows: amoxicillin 25.8%; co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%; amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%; ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin and/or co-trimoxazole use in the previous 3 months was significantly associated with isolation of a co-trimoxazole-resistant E. coli isolate. The same applied for previous use of a fluoroquinolone agent and isolation of a ciprofloxacin-resistant E. coli isolate. In conclusion, increased co-trimoxazole non-susceptibility rates undermine its use as a first-line agent in empirical treatment, especially in cases of recent use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display potent in vitro activity against community uropathogens, but prudent use is warranted for uncomplicated infections. Mecillinam and nitrofurantoin could serve as effective front-line agents in an effort to design fluoroquinolones-sparing regimens.
Full-text · Article · Nov 2009 · International journal of antimicrobial agents
[Show abstract][Hide abstract] ABSTRACT: Background: In a highly antibiotic consumer country, this study aimed to investigate dentists’ attitudes related to antibiotic prescription policies.
Methods: In January 2009, a questionnaire was mailed to 5,200 Greek dentists representing approx. 50% of registered members nationally. Demographic data, antibiotic prescription habits for dental infections and infective endocarditis prophylaxis (IEP) were among the main topics of investigation (10 questions).
Results: A total of 595 appropriately filled questionnaires were returned; mean age (± SD) of responders 47.6(±9.5) years, mean professional experience 21(±9.7) years and 58% of responders were male. One or two antibiotic courses per week (ACW) irrespectively of the cause were reported by 70.6%, 3-5 ACW by 18.7%, >6 ACW by 5.2% and 3.9% reported no prescriptions at all. First-choice antimicrobial was amoxicillin (74.6%) or amoxicillin/clavulanate (19.2%). Second choice antimicrobials were: amoxicillin/clavulanate(28.9%), metronidazole (19.5%), clindamycin (9.9%) and clarithromycin (9.7%). One or two ACW were prescribed for IEP by 53.8% of responders (89.1% of prescriptions were amoxicillin). Only 23% IEP regimens were dosage and duration-appropriate according to HCDCP recommendations (2g of amoxicillin 1h prior to the procedure). In 26.4% of responders IEP was continued for 2 or more days after the procedure. Almost 30% of the dentists reported that patients asked for an antibiotic prescription. Among responders 96.7% voted for continuous education in antibiotic policies.
Conclusion: In countries with high antibiotic consumption in the community, dentists’ contribution should be taken into consideration. Continuous education is warranted for the appropriate antibiotics use in terms of indications and duration of treatment/prophylaxis.
[Show abstract][Hide abstract] ABSTRACT: Background: Daptomycin doses over 6mg/kg/24h demonstrated efficacy in gram positive, difficult-to treat infections.However, relative clinical experience is limited. We assessed safety and efficacy of high doses of daptomycin given for complicated skin and soft tissue infections (cSSTI) .
Methods: Demographics, previous unsuccessful antimicrobials ( PUA), duration of daptomycin treatment (DAT), adverse events (AE) and final outcome were comparatively evaluated between the HD ( high dose- 8mg/kg/day) vs SD (standard dose-6mg/kg/day) group of cSSTI by Fischer exact and Man-Whitney tests accordingly.
Results: Forty patients (median age 61y,range18-89),with comorbidities (72.5%) and PUA (75%) had cSSTI by MRSA (n=7), CoNS(n=9), Enterococcus spp (n=3), and co-existed gram negatives (n=5) requiring antimicrobial co-administration.. HD ( n=8) vs SD (n=32) group did not differ regarding age, gender, comorbidities, PUA, DAT(mean ± SD 10.7 ± 6 days), and successful outcome ( 85% ). HD patients had fever( 80%) and received PUA in 82.5% vs 71% of SD ones(p=0.6). AE related to daptomycin were recorded in 5/32 (15.6%) of the SD vs 2/8 (25%) of the HD group (p=0.6).
( n=7) Dosage
Day of manifestation
Total duration of daptomycin
Elevated AST, ALT
7th stop drug
Conclusion: All AE of daptomycin in both SD and HD patients were equally mild, reversible, not leading to drug discontinuation but in 2 cases.No elevated serum CPK levels were detected. We assumed that high doses of daptomycin are safe and efficacious in severe, non-responding complicated skin and soft tissue infections.