e., time of clampage of the aorta, septic shock, concomitant

use of vasopressive agents) [30, 31]. No eosinophilic pneumonia was observed in our study. Unlike vancomycin, DAP has shown similar efficacy against both MRSA and MSSA, making it an attractive option for empirical therapy of suspected severe infections due to Gram-positive cocci [5–7, 13–17, 19–22]. DAP exhibits bactericidal activity against both methicillin-susceptible and -resistant staphylococci, including those with MIC >1 mg/L, and, in vitro, it kills bacteria faster than comparable drugs anti-PD-1 antibody [7, 8]. Experimental studies [5, 6, 13–17] suggest that it may prevent bacterial adherence, penetrate into the biofilm and prevent further biofilm formation. In the present study, >80% of PVGI

were microbiologically documented. Once the results of bacterial culture were available, empiric antimicrobial therapy was adapted, using, if possible, a step-down strategy. All patients underwent adaptation of antimicrobial drugs during the post-operative period, which we feel is crucial to prevent recolonization of the newly implanted graft. During their hospital stay, five patients died; deaths were related to graft disruption, possibly explained by problems in anastomosis between the graft and the infected aorta tissues. However, in our study, the efficacy of DAP in PVGI cannot be determined. Indeed, the overwhelming majority of patients received beta-lactam antibiotics with or without aminoglycosides in addition to DAP. A secondary surgery procedure was required for 10 patients with persistent infection. For these last patients, we considered Palbociclib supplier that the first surgery was not considered to be optimal. Randomized studies would be more appropriate to study the efficacy of DAP in patients treated for PVGI. The main limitation would be the homogenous patients treated with homogenous surgical and medical procedure. Conclusion In conclusion, results of the present study suggest that high-dose DAP (i.e., >8 mg/kg)

for patients with PVGI due to Gram-positive cocci represents a potentially interesting option for treatment of such infections. High-dose DAP therapy has a satisfactory toxicity profile even in severely ill patients with multiple PAK5 comorbidities, and might favorably compete with vancomycin, especially in terms of risk of induced nephrotoxicity. However, monitoring of CPK levels is recommended in these patients, especially if they are concomitantly treated with statins. Acknowledgments No funding or sponsorship was received for this study or publication of this article. We thank Jerri Bram for her English language assistance. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. A part of this work has been submitted for the next ESCMID in Berlin, Germany.