简介急性嗜酸性粒细胞肺炎(AEP)是一种罕见的呼吸道疾病,由嗜酸性粒细胞在肺组织中的积累引起,可能与药物施用有关。达托霉素,一种对抗革兰氏阳性菌的抗生素,是药物中AEP的主要原因之一。为了提高对这种罕见综合征的认识,在我们的工作中,我们描述了一例82岁男性粪肠球菌心内膜炎的达托霉素治疗,他开发了达托霉素诱导的AEP。我们对所有类似报告病例的文献进行了系统回顾。方法根据系统评价和荟萃分析(PRISMA)报表的首选报告项目进行系统评价。为了进行分析,术语“达托霉素和伊西诺普*和pneum*”,进入了Medline数据库,Cinahl和Embase在4月13日,2023年。我们考虑了使用达托霉素后记录AEP的所有记录。没有年份或语言方面的限制。通过纽卡斯尔-渥太华量表对观察性研究进行了正式评估。所有结果和数据均通过表格报告。结果我们的搜索确定了93条相关记录,2007年至2023年出版。总共考虑了120名患者。经历AEP的患者大多为男性(n=88,73.3%),平均年龄为68.28岁(SD11.54)。达托霉素最常用于骨关节感染(n=75,62.5%)和治疗革兰氏阳性球菌感染。最常见的病原体是耐甲氧西林金黄色葡萄球菌(MRSA)。达托霉素主要用于标签外适应症(n=89,74%)。AEP的症状通常在平均治疗21.75天后报告(范围3-84),通常包括发烧,呼吸困难,干咳和急性呼吸衰竭。报告的治疗策略总是包括达托霉素停药,呼吸支持,和皮质类固醇治疗。116名患者完全康复。在4例患者中描述了致命的结果。暗示症状和影像学检查怀疑AEP,57.5%的病例经支气管肺泡灌洗证实。讨论和结论达托霉素诱导的AEP是一种罕见但可能致命的并发症。大部分报道是在达托霉素长期治疗后。临床医生应该意识到这种综合征,因为它最初可能被误诊为急性传染性呼吸道综合症,导致其诊断和治疗的延误。此外,由于长期接触药物会增加AEP的风险,讨论在更长的治疗方案中使用达托霉素时应谨慎使用。
BACKGROUND: Acute eosinophilic pneumonia (AEP) is a rare respiratory condition caused by eosinophil accumulation in the pulmonary tissue that can be related to drug administration. Daptomycin, an antibiotic active against gram-positive bacteria, is one of the leading causes of AEP among drugs. In order to raise awareness of this rare syndrome, in our work we have described a
case of an 82-year-old male with Enterococcus faecalis endocarditis treated with daptomycin, who developed a daptomycin-induced AEP. We have performed a systematic review of the literature for all similar reported cases.
METHODS: The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. To conduct the analysis, the terms \"daptomycin AND eosinoph* AND pneum*\" were entered into the databases Medline, CINAHL, and Embase on April 13, 2023. We considered all relevant records documenting AEP after daptomycin use. No restrictions in terms of year or language were made. A formal appraisal of observational studies was performed by Newcastle-Ottawa Scale. All results and data were reported by means of tables.
RESULTS: Our search identified 93 relevant records, published between 2007 and 2023. A total of 120 patients were considered. Patients who experienced AEP were mostly males (n = 88, 73.3%) with a mean age of 68.28 years (SD 11.54). Daptomycin was most frequently prescribed for osteoarticular infections (n = 75, 62.5%) and to treat gram-positive cocci infections. The most frequently isolated pathogen was methicillin-resistant Staphylococcus aureus. Daptomycin was mostly used with off-label indications (n = 89, 74%). Symptoms of AEP were usually reported after a mean of 21.75 days of treatment (range 3-84) and typically included fever, dyspnea, dry cough, and acute respiratory failure. Reported treatment strategies invariably included daptomycin withdrawal, respiratory support, and corticosteroid treatment. One hundred and sixteen patients fully recovered. A fatal outcome was described in 4 patients. Suggestive symptoms and imaging raised suspicion for AEP, confirmed with bronchoalveolar lavage in 57.5% of the cases.
CONCLUSIONS: Daptomycin-induced AEP is a rare but potentially fatal complication, mostly reported after long treatment with daptomycin. Clinicians should be aware of this syndrome, as it could be initially misdiagnosed for an acute infectious respiratory syndrome, resulting in a delay in its diagnosis and treatment. Furthermore, since the risk of developing AEP is increased by longer drug exposure, caution should be used when discussing the use of daptomycin in longer treatment regimens.