Risk Factors of Daptomycin-Induced Eosinophilic Pneumonia in a Population with Osteoarticular Infection

Soldevila‐Boixader, Laura; Villanueva, Bernat; Ulldemolins, Marta; Benavent, Eva; Padullés, Ariadna; Ribera, Alba; Borras, I.; Ariza, Javier; Murillo, Óscar

doi:10.3390/antibiotics10040446

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…Among our cohort, only 1.7% of patients who received daptomycin for BJI developed a DIEP whereas they received a median daily dose of 8.2 mg/kg. This is lower than the 4.8% found in a recently published study by Soldevila-Boixader et al [ 25 ]. Unfortunately, in that study, dosages were only expressed in milligrams or total cumulative doses, and there is no information of dosages in milligrams per kilogram, which seems more relevant.…”

Section: Discussioncontrasting

confidence: 68%

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm

Pham

Garreau

Craighero

et al. 2022

Open Forum Infectious Diseases

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Background Daptomycin is increasingly used in the treatment of bone and joint infections (BJI) and may be responsible for daptomycin-induced eosinophilic pneumonia (DIEP), a potentially severe adverse drug reaction. The aim of this study was to describe DIEP in patients treated at a referral centre for the management of BJI, and to revisit current definitions of this disease. Method Patients treated from 01.01.2012 to 31.03.2021 were included in a prospective cohort (NCT02817711), in which all potential serious adverse events are prospectively recorded. Patients diagnosed with DIEP were retrospectively analysed using different definitions. Results In a total of 4,664 patients included in the cohort during the study period, 1,021 patients (21.9%) received daptomycin, of whom 17 (1.7%) were diagnosed with DIEP. Most patients were male (n = 11, 64.7%) and peri-prosthetic joint infection was the commonest BJI (n = 12, 70.6%). Only one patient had bronchoalveolar lavage (BAL) eosinophil count ≥25%, while most patients had peripheral blood eosinophilia (n = 15, 88.2%). Chest CT was compatible with eosinophilic pneumonia in 13/14 cases (92.9%). All patients recovered upon discontinuation of daptomycin. Using the different definitions available, only a minority of cases fulfilled existing criteria for DIEP. We propose a new algorithm that includes specific CT scan signs, and systemic instead of BAL eosinophilia. Conclusion DIEP is a rare event that requires prompt discontinuation of the causative antibiotic. Current criteria to diagnose definite DIEP are too restrictive and not easily applicable in clinical practice. A new algorithm is proposed here (Lyon algorithm) to facilitate the early identification of DIEP.

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Section: Discussioncontrasting

confidence: 68%

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm

Pham

Garreau

Craighero

et al. 2022

Open Forum Infectious Diseases

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“…The rest of the cases were treated with less than 6 mg/kg/day of daptomycin for a median of 23 days [ 3 ]. Some of the risk factors identified by Soldevila et al for developing daptomycin-induced AEP include advanced age, high values of the Charlson comorbidity score, high total cumulative daptomycin dose, specifically more than 10 g, and prolonged therapy of more than two weeks [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Daptomycin-Induced Eosinophilic Pneumonia Mimicking Multifocal Pneumonia

Algayoum¹,

El‐Sherif²,

Khan³

et al. 2022

Cureus

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A 71-year-old female presented to the emergency department with worsening dyspnea, dry cough, malaise, weight loss, fever, chills, and diaphoresis for one week. The patient had been hospitalized four weeks prior with right knee methicillin-resistant Staphylococcus aureus (MRSA) bursitis and was initially treated with IV vancomycin but was switched to IV daptomycin at the time of discharge for convenience of dosing. On presentation to the ED, vitals were normal. Physical examination revealed bilateral scattered rhonchi and crepitations. Chest X-ray revealed new patchy bilateral interstitial and airspace opacities concerning for multifocal pneumonia. Labs were pertinent for mild peripheral eosinophilia. CT chest revealed moderate diffuse ground glass opacities involving both lungs, with subpleural predominance and some areas of septal thickening seen as well. Daptomycin-induced pneumonitis was suspected, and empiric antibiotics were discontinued. The patient subsequently underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy. BAL fluid showed leukocytosis and eosinophilia of 25 mm 3 . Right upper lobe biopsy demonstrated foci of alveolar spaces with collections of eosinophils and histiocytes consistent with acute eosinophilic pneumonia. The patient was started on oral prednisone and albuterol breathing treatments with significant improvement after 48 hours from admission. She was discharged on albuterol inhalers and prednisone taper.Acute eosinophilic pneumonia (AEP) is a lung condition that can be rapidly progressive, leading to significant morbidity and mortality. Daptomycin-induced AEP can mimic community-acquired pneumonia, resulting in delayed diagnosis and management. Recognizing the temporal association between drug initiation and the development of symptoms is crucial in the diagnosis of drug-induced AEP. If it is recognized and treated in a timely manner, the prognosis is generally excellent, with rapid and complete clinical recovery as demonstrated by our case.

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“…Five of the seven patients were also treated with systemic corticosteroids, and two patients reported EP recurrence after the re-administration of DAP. In another retrospective study [ 7 ], the risk factors for DAP-induced EP were age ≥ 70 years and duration of therapy > 14 days. In our study, the median age and the median number of days from DAP initiation to EP onset were identified as risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…In an observational study including 102 patients with infectious endocarditis treated with a DAP dose of 8.2 mg/kg, three patients developed EP [ 14 ]. In a retrospective study [ 7 ], a total dose of DAP > 10 g was observed as a risk factor in an unadjusted analysis. Hayes et al hypothesized that DAP may cause EP by binding with the human pulmonary surfactant, resulting in its accumulation in the alveolar spaces at concentrations high enough to injure the epithelium and cause inflammation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…EP are characterized by marked accumulations of infiltrating eosinophils in the alveolar space and the interstitium. Although EP can lead to hypoxemia and serious complications, very few studies have been published on its risk factors, including literature reviews and a study with a small sample size [ 6 , 7 ]. These studies reported that older age and a total DAP dose > 10 g are risk factors for DAP-induced EP.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Daptomycin-Induced Eosinophilic Pneumonia

et al. 2022

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The risk factors for eosinophilic pneumonia (EP) remain unclear. We investigate the characteristics of patients with daptomycin (DAP)-induced EP and conducted a retrospective observational study. A total of 450 patients aged ≥ 18 years who received DAP (25 DAP with EP, 425 DAP without EP) were included. The median duration from the first DAP administration to EP onset was 18.0 days. Definite, probable, and possible DAP-induced EP were diagnosed in 0, 9, and 16 patients, respectively. The median age (DAP with EP, 72.0 years; DAP without EP, 64.0 years), DAP dosage/body weight (BW) (9.00 vs. 7.50 mg/kg), blood eosinophil count (cells/μL) (419 vs. 96), and the percentage of hemodialyzed patients (40.0% vs. 13.4%) were significantly higher in patients with EP than in patients without EP in the univariate analysis. In separate multivariate logistic regression analyses, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.00–1.05), DAP dosage/BW (OR, 1.61; 95% CI, 1.25–2.07), and hemodialysis (OR, 4.42; 95% CI, 1.86–10.5) were significantly associated with DAP-induced EP. Clinicians may need to consider the potential factors associated with EP, especially in older patients, patients on hemodialysis, or patients who receive > 9.00 mg/kg of DAP.

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Risk Factors of Daptomycin-Induced Eosinophilic Pneumonia in a Population with Osteoarticular Infection

Cited by 17 publications

References 23 publications

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm

Seventeen Cases of Daptomycin-Induced Eosinophilic Pneumonia in a Cohort of Patients Treated for Bone and Joint Infections: Proposal for a New Algorithm

Daptomycin-Induced Eosinophilic Pneumonia Mimicking Multifocal Pneumonia

Factors Associated with Daptomycin-Induced Eosinophilic Pneumonia

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