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Daptomycin vs. vancomycin for osteoarticular infections due to methicillin-resistant Staphylococcus aureus (MRSA): A nested case-control study
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    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.


    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.


    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].


    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.

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    1U1CI000033301/CI/NCPDCID CDC HHS/United States
    5K12HD001459-13/HD/NICHD NIH HHS/United States
    K12 HD001459/HD/NICHD NIH HHS/United States
    KL2 RR024994/RR/NCRR NIH HHS/United States
    KL2 TR000450/TR/NCATS NIH HHS/United States
    KL2RR024994/RR/NCRR NIH HHS/United States
    KM1 CA156708/CA/NCI NIH HHS/United States
    KM1CA156708/CA/NCI NIH HHS/United States
    U54 CK000162/CK/NCEZID CDC HHS/United States
    UL1 RR024992/RR/NCRR NIH HHS/United States
    UL1 TR000448/TR/NCATS NIH HHS/United States
    UL1RR024992/RR/NCRR NIH HHS/United States
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