Acta Vulnologica 2011 March;9(1):3-9

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English, Italian

Daptomycin in the disinfection of complicated infected skin ulcers of the lower limbs in geriatric patients and candidates for reconstructive and/or regenerative surgery

Campitiello F., Della Corte A., Padovano Sorrentino V., Califano U., Mancone M., Canonico S.

Section of Surgery, Department of Gerontology, Geriatrics and Metabolism Disorders, Naples Second University, Naples, Italy

Aim. Skin and soft tissue infections are an emerging problem and a frequent cause of hospitalization. The aim of this observational study was to evaluate the efficacy of daptomycin in the disinfection and the modulation of the inflammatory response of complicated infected skin ulcers.
Methods. From April 2009 to September 2010, 24 patients with complicated skin ulcer of the lower limbs were enrolled in the study. The inclusion criteria were: previous hospitalization and documented treatment failure with systemic antibiotics; least two signs/symptoms of infection; bacterial culture demonstrating Gram-positive infection. Patients were excluded if they presented with severe necrotizing fasciitis, osteomyelitis, neutropenia, gangrene, peripheral arterial insufficiency (IW <0.6), CPK >200 U/L, CCr <30 mL/min. CPK and creatinine clearance were measured at 7 and 14 days after admission if CPK values were within normal limits or every 3 days values were outside the normal range. Daptomycin was given either alone or in combination with antibiotics active against Gram-negative bacteria (antibiotic therapy was guided by susceptibility testing and MIC), at a dose of 4 mg/kg every 24 h for an average duration of 15 days.
Results. The bacterial culture demonstrated: Gram-positive strains in 20.83% of cases which subsequently received daptomycin monotherapy, and mixed infection of Gram-positive and Gram-negative strains in 79.16% of cases which received daptomycin and a second antibiotic (ceftriaxone 57.89%, netilmicin 5.2%, meropenem 15,78%, ciprofloxacin 21.05%). The Gram-negative species were: Acinetobacter baumanii (5.26%), Pseudomonas aeruginosa (36.84%), Klebsiella pneumoniae (15.78%), Enterobacter gergoviae (10.52%), and Enterobacter cloacae (21.05%).
Conclusion. Remission of clinical signs of inflammation was observed in 100 % of cases within three days on average after the beginning of antibiotic treatment. Complete clearance of lesions was noted in all patients within six days. Our results show that daptomycin may offer the advantage of faster resolution of infection, with subsequent reductions in the duration of therapy, length of hospital stay, and in health care costs.