Clinical Outcomes of Daptomycin with and without Concomitant ?-lactams in Patients with Staphylococcus aureus Bacteremia and Mild to Moderate Renal Impairment: A Multicenter Evaluation.
Antimicrob Agents Chemother. 2012 Dec 17;
Authors: Moise PA, Amodio-Groton M, Rashid M, Lamp KC, Hoffman-Roberts HL, Sakoulas G, Yoon MJ, Schweitzer S, Rastogi A
Patients with underlying renal disease may be vulnerable to vancomycin-mediated nephrotoxicity and Staphylococcus aureus bacteremia treatment failure. In light of recent data demonstrating successful use of ?-lactam plus daptomycin combination in very difficult cases of S. aureus bacteremia, we examined safety and clinical outcomes in patients who received daptomycin with or without concomitant ?-lactams. One hundred six patients who received daptomycin for S. aureus bacteremia, had mild or moderate renal insufficiency using FDA criteria, and enrolled in CORE (Cubicin Outcomes Registry and Experience), a multicenter registry from 2005 to 2009 were identified. Daptomycin-treatment success was 81%. Overall treatment efficacy was slightly enhanced with the addition of a ?-lactam (87% vs. 78%, P = 0.336), but this trend was most pronounced in bacteremia associated with endocarditis, bone/joint infection, and bacteremia of unknown source (90% vs. 57%, P = 0.061). Factors associated with reduced daptomycin efficacy (by logistic regression) were unknown source of bacteremia (OR 7.59; 95% CI 1.55-37.2), moderate renal impairment (OR 9.11; 95% CI 1.46-56.8), and prior vancomycin failure (OR 11.2; 95% CI 1.95-64.5). Two patients experienced an increase in CPK that resolved after stopping daptomycin. No patients developed worsening renal insufficiency related to daptomycin. In conclusion, daptomycin appeared to be effective and well tolerated in patients with S. aureus bacteremia with mild to moderate renal insufficiency. Daptomycin treatment efficacy might be enhanced with ?-lactam combination therapy in primary endovascular and bone/joint infections. Additional studies will be necessary to confirm these findings.
PMID: 23254428 [PubMed - as supplied by publisher]