Outcomes with daptomycin versus standard therapy for osteoarticular infections associated with Staphylococcus aureus bacteraemia

• Published in: Journal of antimicrobial chemotherapy Vol. 61; no. 1; pp. 177 - 182
• Main Authors: Lalani, T., Boucher, H. W., Cosgrove, S. E., Fowler, V. G., Kanafani, Z. A., Vigliani, G. A., Campion, M., Abrutyn, E., Levine, D. P., Price, C. S., Rehm, S. J., Corey, G. R., Karchmer, A. W.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2008; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial arthritis and osteitis; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Clinical outcomes; Clinical trials; Comparative studies; complicated bacteraemia; Daptomycin - administration & dosage; Daptomycin - therapeutic use; Drug Administration Schedule; Female; Human bacterial diseases; Humans; Infectious diseases; Injections, Intravenous; Male; Medical sciences; Microbiology; Middle Aged; Osteoarthritis - drug therapy; Osteoarthritis - microbiology; osteomyelitis; Pharmacology. Drug treatments; septic arthritis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Staphylococcus infections; treatment; Treatment Outcome; osteomyelitis; treatment; septic arthritis; complicated bacteraemia; Prognosis; Peptides; Diseases of the osteoarticular system; Daptomycin; Arthritis; Bacteremia; Standards; Infection; Antibiotic; Treatment; Osteitis; Bacteriosis; Bacteria; Micrococcales; Complication; Micrococcaceae; Antibacterial agent; Staphylococcal infection; Lipopeptide; Comparative study; Staphylococcus aureus
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm437

Objectives To evaluate the clinical characteristics, treatment and outcomes of patients with osteoarticular infections (OAIs) associated with Staphylococcus aureus bacteraemia (SAB). Methods The clinical characteristics and outcomes for patients with OAI were described using a post hoc analysis of an open label, randomized trial comparing daptomycin with standard therapy (vancomycin or anti-staphylococcal penicillin with initial gentamicin) for the treatment of SAB. Results OAI occurred in 32 of 121 patients (21 daptomycin and 11 standard therapy) with complicated SAB (18 septic arthritis, 9 vertebral osteomyelitis and 7 others). Two patients had osteomyelitis in more than one site. Success rates seen in two groups were as follows: vertebral osteomyelitis [3/5 (60%) daptomycin versus 0/2 (0%) comparator], septic arthritis [7/11 (64%) versus 3/5 (60%)], sternal osteomyelitis [3/3 (100%) versus 1/2 (50%)] and long bone osteomyelitis [0/1 (0%) versus 1/1 (100%)]. Success rates in both treatment groups improved with surgical therapy. Creatine phosphokinase elevations to >500 IU/L occurred in one patient on daptomycin who discontinued therapy, whereas renal impairment developed in three patients on standard therapy, two of whom discontinued therapy. Two patients treated with daptomycin and one patient on vancomycin had increases in S. aureus MICs to daptomycin and vancomycin, respectively. Three patients treated with daptomycin died following completion of therapy, with mortality attributed to multiple co-morbid conditions and inadequate debridement of OAIs in these patients. No deaths were reported in the standard therapy group. Conclusions Daptomycin may be considered an alternative to standard therapy in the treatment of patients with complicated SAB and OAI.