Daptomycin vs. Vancomycin for Osteoarticular Infections Due to Methicillin-Resistant Staphylococcus aureus (MRSA): A Nested Case-Control Study

Details

• Alternative Title:
  Eur J Clin Microbiol Infect Dis
• Personal Author:
  Liang, Stephen Y. ; Khair, Hani N. ; McDonald, Jay R. ; Babcock, Hilary M. ; Marschall, Jonas
• Description:
  Purpose ; Vancomycin is the standard antibiotic for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. While daptomycin is approved for MRSA bacteremia, its effectiveness in osteoarticular infections (OAI) has not been established. ; Methods ; 1:2 nested case-control study of adult patients with MRSA OAI admitted to an academic center from 2005-2010. Clinical outcomes and drug toxicity in patients treated with daptomycin vs. vancomycin were compared. ; Results ; 20 patients with MRSA OAI treated with daptomycin were matched to 40 patients treated with vancomycin. Median age 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 other antibiotics than daptomycin 22 (55%) vs. 5 (25%); p=0.03. Median total antibiotic treatment duration was 48 (daptomycin) vs. 46 days (vancomycin) (p=0.5). 90% of daptomycin-treated patients had previously received vancomycin for a median 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. Frequency of adverse events was similar between treatment groups 1 (5%) vs. 7 (18%); p=0.2. ; Conclusions ; 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.
• Keywords:
  • Staphylococcus aureus
  • osteomyelitis
  • septic arthritis
  • daptomycin
  • vancomycin
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents
  • Bone Diseases, Infectious
  More +
• Source:
  Eur J Clin Microbiol Infect Dis. 33(4):659-664
• Pubmed ID:
  24186726
• Pubmed Central ID:
  PMC3955410
• Document Type:
  Text
• Funding:
  K12 HD001459/HD/NICHD NIH HHSUnited States/ ; 1U1CI000033301/CI/NCPDCID CDC HHSUnited States/ ; KL2RR024994/RR/NCRR NIH HHSUnited States/ ; UL1 TR000448/TR/NCATS NIH HHSUnited States/ ; U54 CK000162/CK/NCEZID CDC HHSUnited States/ ; KL2 RR024994/RR/NCRR NIH HHSUnited States/ ; KM1CA156708/CA/NCI NIH HHSUnited States/ ; KM1 CA156708/CA/NCI NIH HHSUnited States/ ; UL1RR024992/RR/NCRR NIH HHSUnited States/ ; UL1 RR024992/RR/NCRR NIH HHSUnited States/ ; 5K12HD001459-13/HD/NICHD NIH HHSUnited States/ ; KL2 TR000450/TR/NCATS NIH HHSUnited States/
  More +
• Genre:
  Journal Article
• Volume:
  33
• Issue:
  4
• Download URL:
  https://stacks.cdc.gov/view/cdc/29882/cdc_29882_DS1.pdf
• File Type:
  [PDF - 117.29 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:d42198c7c034967db69b8b8e46ef27c59b8204a8e924c9104c5343d1c3bd3c06b780bd0d31ed4d1161a2494eb84814e58eb59b8c5fc202d6ed7d51300fb35e01