Daptomycin Efficacy Assessed After Vancomycin Failure in MRSA Bacteremia

Patients who received daptomycin following ≥72 hours of vancomycin were included in the study
Patients who received daptomycin following ≥72 hours of vancomycin were included in the study

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SAN DIEGO—Pramodini Kale-Pradhan, PharmD, from Wayne State University, Detroit, MI, reported that daptomycin was effective in a majority of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia who failed vancomycin therapy. 

With persistent MRSA bacteremia despite vancomycin therapy, clinicians commonly switch therapy in patients. Dr. Kale-Pradhan and coauthors sought to examine the use of daptomycin in these patients who have failed vancomycin therapy through a single-center, retrospective evaluation. 

Adult patients who received daptomycin after vancomycin for MRSA bacteremia from January 2011 to September 2016 were included for review. "Persistent bacteremia was defined as continued positive blood culture(s) despite receiving more than 72 hours of vancomycin," explained Dr. Kale-Pradhan. The team of researchers evaluated appropriateness of the daptomycin dose, the duration of bacteremia, creatinine phosphokinase (CPK) levels, hospital length of stay, and patient disposition. 

A total of 700 patients received daptomycin during the study period; 596 did not meet the inclusion criteria. Thirty patients met inclusion criteria, 73.7% of patients cleared bacteremia with daptomycin. Daptomycin doses ranged from 4mg/kg to 10mg/kg. Ten patients, however, were switched back to vancomycin due to persistent bacteremia (n=6), increase in daptomycin minimum inhibitory concentration (MIC; n=3), and negative blood culture on the date daptomycin was initiated (n=1).

The duration of bacteremia was shorter while receiving treatment with daptomycin vs. vancomycin (4.9±5.4 days vs. 8.5±6.6 days). The authors observed appropriate use of daptomycin in 97.4% of patients who failed vancomycin according to the current protocol.

Dr. Kale-Pradhan concluded, "Daptomycin was effective in a majority of the patients in clearing bacteremia but MICs increased in some patients." Additional studies are warranted to validate these findings. 

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Reference:

Kale-Pradhan, Pramodini PharmD. Effectiveness of Daptomycin in Patients with Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia Despite Vancomycin. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org