Aim: To review preclinical and clinical data relevant to daptomycin lock therapy in catheter-related bloodstream infection (CRBSI). Methods: Systematic review in PubMed, Scopus and clinical trial registries. Results: Preclinical data demonstrate daptomycin lock solution stability and compatibility with heparin, good biofilm penetration, bactericidal activity against biofilm-embedded bacteria, and high efficacy in vitro and in animal catheter infection models. Clinical data remain limited (two case reports and five case series totaling n = 65 CRBSI episodes), albeit promising (successful catheter salvage in about 80% of cases). Conclusion: Despite theoretical advantages of daptomycin, clinical data remain scarce. Comparative studies versus alternative lock solutions are needed, as well as studies to define optimal daptomycin lock regimen (including optimal concentration, dwell time and lock duration).
Keywords: biofilm; catheter-related bloodstream infection; daptomycin; lock; systematic review.
Some patients, such as those needing cancer treatments, kidney dialysis or to be fed through a vein, need long-term access to central veins by a tube called a catheter. These central venous catheters can often become infected and will need to be removed and replaced. Sometimes, the catheter can be saved by ‘locking’ the tube with a solution to kill any germs. In this review, we discuss the potential to use an antibiotic called daptomycin as the solution in lock therapy. Available data are reviewed and advantages over alternative antimicrobial lock solutions are discussed. Finally, directions for future research are proposed.