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The Efficacy of Daptomycin vs. Vancomycin for MRSA Bloodstream Infection in Patients with Impaired Renal Function.
Clin Infect Dis. 2014 Mar 18;
Authors: Weston A, Golan Y, Holcroft C, Snydman DR
Abstract
Background. Concerns regarding the efficacy of daptomycin for Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections in patients with impaired renal function are reflected in a recent package insert change by the FDA. However, this decision was based on a small subgroup analysis and it is unclear if this is a true association. Methods. We conducted a retrospective cohort study of patients with MRSA bacteremia treated at a tertiary hospital from 2001-2011 and who received either vancomycin or daptomycin. We used propensity score and multivariable logistic regression to assess the outcome of treatment failure, via blinded adjudication, in daptomycin vs. vancomycin treated subjects and the interaction with renal function. Results. There were 150 patients analyzed, 100 in the Vancomycin arm and 50 in the Daptomycin arm. The average age was 61 and 60% were men. Of patients treated with daptomycin or vancomycin, 29 (58%) and 51 (51%), respectively, had a GFR <50 ml/min/1.73 m(2). Compared to vancomycin, neither the usage of daptomycin in patients with a GFR>50 ml/min/1.73 m(2) (OR 0.45, 95% CI 0.11-1.79) nor in patients with a GFR of <50 ml/min/1.73 m(2) (OR 0.46, 95% CI 0.11-1.94) was significantly associated with treatment failure. There was no significant interaction between them (p=0.54). Conclusions. In patients with MRSA bacteremia, daptomycin efficacy was not affected by GFR level and was similar to vancomycin's efficacy. Although our sample size was small, it was larger than than the one used by the FDA. However, smaller differences may be significant with a larger sample size.
PMID: 24642554 [PubMed - as supplied by publisher]