比較Daptomycin與Glycopeptides抗生素對於抗藥性金黃色葡萄球菌脊椎骨髓炎治療效果

Daptomycin Versus Glycopeptide for the Treatment of Methicillin-Resistant Staphylococcus Aureus Vertebral Osteomyelitis

10.6168/FJCP.201810_26(4).0006

盧柏先(Po-Hsien Lu)；蔡慈貞(Tzu-Cheng Tsai)

抗藥性金黃色葡萄球菌 ； 脊椎骨髓炎 ； Daptomycin ； Glycopeptides ； Methicillin-Resistant Staphylococcus Aureus ； Vertebral Osteomyelitis ； Daptomycin ； Glycopeptides

臺灣臨床藥學雜誌

26卷4期（2018 / 10 / 31）

295 - 302

繁體中文

目的：Daptomycin為環脂肽抗生素，作用機轉主要是與細菌細胞膜結合以破壞其功能，與作用在細胞壁的glycopeptides抗生素不同，然而臨床上應用於抗藥性金黃色葡萄球菌脊椎骨髓炎經驗仍相當有限，本研究主要探討daptomycin用於抗藥性金黃色葡萄球菌脊椎骨髓炎效果並且與glycopeptides抗生素比較。方法：本研究採用回溯性病歷回顧，收集時間自2008年1月1日至2013年12月31日，有使用daptomycin或glycopeptides抗生素治療抗藥性金黃色葡萄球菌脊椎骨髓炎的案例。並且利用存活分析比較兩組抗生素治療效果。結果：本研究收錄共51位抗藥性金黃色葡萄球菌脊椎骨髓炎病人，其中使用daptomycin有17位，glycopeptides有34位，平均抗生素使用時間分別為39.7 ± 11.4天與48.4 ± 23.8天，結果顯示以daptomycin治療成功率可以達82.5%，而glycopeptides治療為58.2% (p = 0.05)。結論：抗藥性金黃色葡萄球菌脊椎骨髓炎治療目前缺乏前瞻性、隨機對照試驗探討daptomycin治療效果，但從本研究可發現daptomycin對於抗藥性金黃色葡萄球菌脊椎骨髓炎治療效果是優於glycopeptides抗生素。

Objective: Daptomycin is a cyclic lipopeptide that has a unique mechanism of action involving a calcium-dependent dissipation of membrane potential, leading to the release of intracellular ions from the cell and bacteria death. We assessed and compared the efficacy of daptomycin and glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) vertebral osteomyelitis. Methods: We conducted a retrospective chart review of all patients who received daptomycin or glycopeptides for MRSA vertebral osteomyelitis. The Kaplan-Meier analysis was used to assess the cure rate. Results: Fifty-one patients were identified receiving either daptomycin (n = 17) or glycopeptides (n = 34) for MRSA vertebral osteomyelitis. The mean duration of antibiotic therapy was 39.7 ± 11.4 days for daptomycin and 48.4 ± 23.8 days for glycopeptides. Cure was more likely to be obtained in the patients receiving daptomycin (82.5%) than in the patients treated with glycopeptides (p = 0.05). Conclusions: There is currently a lack of prospective randomized controlled trials of MRSA vertebral osteomyelitis treatment for exploring the efficacy of daptomycin. Our data showed that patients treated with daptomycin had a higher cure rate than those treated with glycopeptides.