Background
Methods
Results
Definite | Probable | Possible | Unlikely |
---|---|---|---|
Concurrent exposure to daptomycin | Concurrent exposure to daptomycin | Concurrent exposure to daptomycin | All other cases that did not meet criteria |
Dyspnea with increased oxygen requirement or requiring mechanical ventilation | Dyspnea with increased oxygen requirement or requiring mechanical ventilation | New infiltrates on CXR or CT | |
New infiltrates on CXR or CT | New infiltrates on chest x-ray or CT | Clinical improvement following daptomycin withdrawal OR the patient died | |
BAL with > 25% eosinophils | BAL with ≤ 25% eosinophils OR peripheral eosinophilia | ||
Clinical improvement following daptomycin withdrawal | Clinical improvement following daptomycin withdrawal | ||
Fever |
Case | Age/Sex | Indication | Dose (mg/kg/day) | DAP Duration (wks) | Clinical Findings | Objective Findings | Treatment | Outcome |
---|---|---|---|---|---|---|---|---|
Kim [1] (2012) | 63/F | MSSA spinal osteomyelitis | 6 | 3 | • Fever • Cough, hypoxemia | • BAL = 60–70% • Peripheral eosinophilia • Elevated CPK | • DAP d/c • Corticosteroids | Recovered |
64/M | Osteomyelitis with bacteremia | 5.7 | 4 | • Fever • Dyspnea, hypoxia | • BAL = 44% • Peripheral eosinophilia • Pulmonary infiltrates | • DAP d/c | Recovered | |
79/M | Endocarditis | 6 | 6 | • Fever, cough, night sweats • Dyspnea requiring MV | • BAL = 9–13% • Peripheral eosinophilia • CT = ground glass opacities • Lung biopsy = eosinophilic pneumonitis | • DAP d/c • Corticosteroids | Improved | |
26/M | MRSA bacteremia | 7.35 | 1.4 | • Dyspnea requiring MV | • BAL not performed • Peripheral eosinophilia • Pulmonary infiltrates • Eosinophils in tracheal aspirate | • DAP d/c | Improved | |
43/M | MRSA osteomyelitis | 6 | 1–2 | • Pleuritic pain • Hypoxia requiring O2
| • BAL not performed • Peripheral eosinophilia • CT = bilateral infiltrates | • DAP d/c • Given NSAIDs, meperidine | • Improved • Residual infiltrates on CT s/p 4 wks | |
66/M | MSSA bacteremia | 6 | 1 | • Dyspnea requiring O2
• Hematemesis | • BAL with eosinophils (not quantified) • Peripheral eosinophilia | • DAP d/c • Corticosteroids | Recovered | |
71/M | MRSA diabetic foot infection | 4 | 7.7 | • Dyspnea requiring O2
| • Peripheral eosinophilia • Elevated CRP • Elevated ESR • CT = bilateral interstitial opacities | • DAP d/c | Improved | |
77/F | Bacteremia (enterococcal) | 5 | 1 | • Dyspnea requiring O2
| • Peripheral eosinophilia • CXR = pneumonitis | • DAP d/c • Corticosteroids | Improved | |
67/M | MRSA endocarditis | 6 | 4.3 | • Dyspnea requiring MV | • BAL = 9% • Peripheral eosinophilia • CT = bilateral pulmonary infiltrates | • DAP d/c • Corticosteroids | Improved | |
73/M | Prosthetic joint infection | 5 | 3.7 | • Fever • Dyspnea requiring MV | • Peripheral eosinophilia • CT = bilateral ground glass appearance | • DAP d/c • Corticosteroids | Recovered | |
81/F | MRSA paraspinal abscess | 6 | 1.6 | • Dyspnea requiring MV | • BAL = 2% (s/p corticosteroid)a
• CXR = bilateral mid-lung infiltrates | • DAP d/c • Corticosteroids | Improved | |
Cobb [6] (2007) | 84/M | Infection of left knee prosthesis | 4 | 4 | • Decreased appetite • Weight loss • Fatigue • Weakness | • Elevated ESR • CT with infiltrates • Lung biopsy = eosinophilic pneumonia | • DAP d/c | • Improved within 2 weeks |
Hayes [7] (2007) | 60/M | MSSA endocarditis | NR | 2 | • Fever, rigors, diaphoresis • Required MV | • BAL 16% initially • BAL 26% after rechallenge • CRP elevated | • DAP d/c – then re-challenged • DAP d/c plus corticosteroids | • Rechallenge failed within 4 h • Improved within 24 h after DAP d/c |
Kakish [8] (2008) | 65/M | MRSA vertebral osteomyelitis, epidural abscess | 6 | 2 | • Low-grade fever • Dyspnea requiring MV | • BAL = 33% • Peripheral eosinophilia • Lung biopsy revealed eosinophils | • DAP d/c • Corticosteroids | • Improved within 72 h • Normal CT at 3 months |
Shinde [9] (2009) | 54/M | Complicated inguinal hernia repair | NR | 2 | • Low grade fever, cough • Hypoxemia requiring MV | • Peripheral eosinophilia • CT = bilateral airspace, peripheral predominance, small bilateral effusions • Lung biopsy = many eosinophils | • DAP d/c • Corticosteroids | • Improved within 24 h • Normal CT at 4 weeks |
Lal [10] (2010) | 82/M | Prosthetic joint infection | NR | 3 | • Fever • Hypoxia requiring O2
| • BAL = 14% • Peripheral eosinophilia • CT = patchy bilateral infiltrates | • DAP d/c • Corticosteroids | • Recovered after 5 days • Recurrent symptoms • Low dose steroids required |
87/M | Prosthetic knee infection | NR | 4 | • Dyspnea, dry cough requiring O2
• Malaise, chills, anorexia, fever | • BAL = 40% • Peripheral eosinophilia • CT = bilateral patchy pulmonary infiltrates | • DAP d/c • Corticosteroids | • Recurrence s/p steroid taper • Low dose steroids for 2 years | |
Miller [11] (2010) | 60/M | MSSA prosthetic hip infection | 6 | 2 | • Cough, fever • Hypoxia requiring O2
| • BAL = 81% after rechallenge • Peripheral eosinophilia • CT = bilateral scattered ground-glass opacities • Lung biopsy = acute fibrinous and organizing pneumonia, reactive alveolar and interstitial epithelial changes | • DAP d/c • Rechallenged, DAP d/c • Corticosteroids | • Improved within 48 h • Rechallenge failed within 24 h |
60/M | MRSA osteomyelitis, septic arthritis | 6 | 2 | • Non-productive cough, dyspnea • Low-grade fevers, chills | • Peripheral eosinophilia • CT = patchy peripheral nodular/ground-glass | • DAP d/c | • Resolution within 96 h • Recurrence with re-challenge at 5 months | |
83/M | Diskitis of lumbar spine | 6 | 4 | • Progressive dyspnea, • Cough, pleuritic chest pain | • BAL = 13% • Peripheral eosinophilia • CT = diffuse ground-glass, reticular opacities • Lung biopsy = acute organizing pneumonia, eosinophilia, chronic inflammation, fibro-inflammatory changes | • DAP d/c • Corticosteroids | Improved within 6 days | |
Kalogeropoulous [12] (2011) | 78/M | Endocarditis | 8 | 1.4 | • Fever, chills, diaphoresis, • Hypoxemia requiring O2
| • BAL = 27.5% • Peripheral eosinophilia • Elevated ESR • Elevated CRP • CT = patchy consolidation, ground-glass opacities, bilateral pleural effusions | • DAP d/c | Resolution within 24 h |
Rether [13] (2011) | 69/M | Spondylo-discitis with lumbar epidural and bilateral psoas abscesses | 6 | 3 | • Fever • Dyspnea requiring O2
| • BAL = 30% • Elevated CRP • CXR = extensive patchy infiltrates in RLL and entire left lung | • DAP d/c • Corticosteroids | Improved within 24 h |
Patel [14] (2014) | 61/F | Osteomyelitis | NR | 1 | • Dry cough • Dyspnea requiring MV | • BAL = 30% • Peripheral eosinophilia • CT = bilateral pleural effusion, diffuse bilateral patchy infiltrate | • DAP d/c • Corticosteroids | Improved within 72 h |
Phillips [15] 2014) | 48/M | Osteomyelitis | 6 | 3 | • Fever • Dyspnea requiring MV | • BAL = 17% • Peripheral eosinophilia • CXR = patchy bilateral airspace opacities | • DAP d/c • Corticosteroids | • Improved |
28/M | Osteomyelitis | 6 | 4 | • Dyspnea requiring MV • Chest pain, light-headedness | • BAL = 74% • Peripheral eosinophilia • CT = diffuse multi-lobar infiltrates | • DAP d/c • Corticosteroids | Resolution within 1 week | |
Yamamoto [16] (2014) | 82/M | MRSA bacteremia | 10 | 2 | • Low grade fever • Hypoxia | • CT = bilateral ground glass opacities • Sputum negative for eosinophils | • DAP d/c | Improved |
Yusuf [17] (2014) | 64/M | Prosthetic joint infection | 10 | 4 | • Fever | • BAL = 47% • Peripheral eosinophilia • Elevated CRP • CT = diffuse bilateral ground-glass opacities | • DAP d/c | Improved within 24 h |
61/M | Prosthetic joint infection | 10 | 2 | • Fever • Dyspnea requiring MV | • BAL = 3% • Peripheral eosinophilia • Elevated CRP • CT = ground-glass consolidation, bilateral pleural effusion | • DAP d/c | Improved within 24 h | |
Chiu [18] (2015) | 77/M | Osteomyelitis | 6 | 6 | • Pleuritic chest pain • Cough, dyspnea requiring O2
| • BAL = 18% • Elevated CRP • CXR = diffuse bilateral airspace disease | • DAP was d/c 1 day before symptoms • Corticosteroids | Improved within 60 h |
74/F | Infected hip reconstruction | 6 | 1b
| • Fever • Dyspnea requiring O2
| • CXR – bilateral airspace disease | • DAP d/c • Corticosteroids | Improved within 24 h | |
Hagiya [19] (2015) | 34/M | Endocarditis | 10 | 1 | • Cough with mild hypoxemia | • Peripheral eosinophilia • Elevated CRP • CT = consolidation in peripheral field of right upper lobe | • DAP d/c | Resolved within 6 weeks |
Hatipoglu [20] (2015) | 67/F | MRSA diabetic foot ulcer | NRc
| 3.3 | • Cough, dyspnea requiring BPAP • Fever, fatigue, decreased appetite | • Peripheral eosinophilia • Elevated CRP • CT = right lobe infiltration | • DAP d/c • Inhaled corticosteroids | Improved within 72 h |
Roux [21] (2015) | 67/M | MSSA prosthetic hip infection | 6 | 2.4 | • Dry cough, hypoxemia | • BAL = 10% • Peripheral eosinophilia • CT = diffuse alveolar and interstitial opacities | • DAP d/c • Corticosteroids | Improved within 96 h |
Wojtaszczyk [22] (2015) | 76/M | Septic arthritis and pacemaker vegetation | NR | 2 | • Dyspnea requiring O2, cough • Fever, fatigue | • BAL = 58% • Elevated CRP • CT = bilateral ground glass opacity, patchy consolidation | • DAP d/c • Corticosteroids | Resolved within 72 h |
Akcaer [23] (2016) | 60/M | MSSA post-amputation abscess | 5 | 3.4 | • Tachypnea, hypoxia requiring O2
| • Peripheral eosinophilia • Elevated CRP • Elevated ESR • HRCT = right pleural effusion, bilateral tree-in-bud pattern, bilateral scattered ground-glass opacities | • DAP d/c | Resolved within 72 h |
Sex, n (%) | |
Male | 29 (83) |
Female | 6 (17) |
Age(years), mean ± SD | 65.4 ± 15 |
Daptomycin indication, n (%) | |
Osteomyelitis/diabetic foot infection | 11 (31) |
Prosthetic joint infection | 9 (26) |
Endocarditis | 5 (14) |
Bacteremia | 4 (11) |
Abscess | 3 (9) |
Other | 3 (9) |
Daptomycin dose (mg/kg/day), mean ± SD | 6.4 ± 1.6 |
Treatment duration at symptom onset (weeks), mean ± SD | 2.8 ± 1.6 |
Clinical findings, n (%) | |
Dyspnea | 33 (94) |
Fever | 20 (57) |
Cough | 13 (37) |
Requiring oxygen | 15 (43) |
Requiring mechanical ventilation | 12 (34) |
Infiltrates/opacities of CT/CXR, n (%) | 30 (86) |
BAL eosinophils %, mean ± SD | 32 ± 22.4 |
Peripheral eosinophilia, n (%) | 27 (77) |
Lung biopsy consistent with AEP, n (%) | 6 (17) |
Treatment, n (%) | |
Daptomycin discontinued only | 12 (34) |
Daptomycin discontinued plus corticosteroid | 23 (66) |