Journal Article

Daptomycin versus vancomycin for osteoarticular infections due to methicillin-resistant Staphylococcus aureus (MRSA): a nested case–control study

Khair, H. N., McDonald, J. R., Marschall, J., Liang, S. Y., Babcock, H. M.

2014

Overview

Vancomycin is the standard antibiotic for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. While daptomycin is approved for MRSA bacteremia, its effectiveness in osteoarticular infections (OAIs) has not been established. A 1:2 nested case–control study of adult patients with MRSA OAIs admitted to an academic center from 2005 to 2010 was carried out. Clinical outcomes and drug toxicity in patients treated with daptomycin versus vancomycin were compared. Twenty patients with MRSA OAIs treated with daptomycin were matched to 40 patients treated with vancomycin. The median age of the patients was 52 years (range, 25–90), and 40 (67 %) were male. Most patients had osteomyelitis (82 %), predominantly from a contiguous source (87 %). Forty percent were diabetics. Diabetic patients were more likely to receive vancomycin than daptomycin [20 (50 %) vs. 4 (20 %); p  = 0.03]. Vancomycin was more often combined with antibiotics other than daptomycin [22 (55 %) vs. 5 (25 %); p  = 0.03]. The median total antibiotic treatment duration was 48 (daptomycin) vs. 46 days (vancomycin) ( p  = 0.5). Ninety percent of daptomycin-treated patients had previously received vancomycin for a median of 14.5 days (range, 2–36). Clinical success rates were similar between daptomycin and vancomycin at 3 months [15 (75 %) vs. 27 (68 %); p  = 0.8] and 6 months [14 (70 %) vs. 23 (58 %); p  = 0.5], even after propensity score-based adjustment for antibiotic assignment. The frequency of adverse events was similar between treatment groups [1 (5 %) vs. 7 (18 %); p  = 0.2]. Daptomycin and vancomycin achieved similar rates of clinical success and drug tolerability. Daptomycin is a reasonable alternative for treating MRSA OAIs, particularly in patients where therapy with vancomycin has not been well tolerated.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Anti-Bacterial Agents - therapeutic use / Antibacterial agents / Antibiotics / Antibiotics. Antiinfectious agents. Antiparasitic agents / Bacteremia / Bacterial diseases / Biological and medical sciences / Biomedical and Life Sciences / Biomedical materials / Biomedicine / Bone Diseases, Infectious - drug therapy / Bone Diseases, Infectious - microbiology / Case studies / Case-Control Studies / Daptomycin / Daptomycin - therapeutic use / Diabetes mellitus / Drug resistance / Female / Human bacterial diseases / Humans / Infectious diseases / Internal Medicine / Male / Medical Microbiology / Medical sciences / Methicillin / Methicillin-Resistant Staphylococcus aureus - isolation & purification / Middle Aged / Osteomyelitis / Patients / Pharmacology. Drug treatments / Staphylococcal Infections - drug therapy / Staphylococcal Infections - microbiology / Staphylococcal infections, streptococcal infections, pneumococcal infections / Staphylococcus aureus / Staphylococcus infections / Toxicity / Treatment Outcome / Vancomycin / Vancomycin - therapeutic use