Clinical Outcomes of Daptomycin versus Anti-Staphylococcal Beta-Lactams in Definitive Treatment of Methicillin-susceptible Staphylococcus aureus Bloodstream Infections

Link to article at PubMed

Int J Antimicrob Agents. 2021 May 22:106363. doi: 10.1016/j.ijantimicag.2021.106363. Online ahead of print.


Staphylococcus aureus is the leading cause of bacteremia and infective endocarditis worldwide. The preferred management of patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia includes definitive therapy with intravenous anti-staphylococcal beta-lactam (ASBL) antibiotics. In beta-lactam allergic or intolerant patients, daptomycin (DAP) has been targeted as a viable substitute. This single-center retrospective cohort study assessed clinical outcomes of daptomycin compared to anti-staphylococcal beta-lactam antibiotics [nafcillin (NAF) or cefazolin (CFZ)] for the treatment of MSSA bacteremia in patients hospitalized from November 1, 2011 to October 31, 2018. The primary outcome was a composite of the following: clinical failure, MSSA recurrence, MSSA persistence or inpatient infection-related mortality. Secondary outcomes included duration of MSSA bacteremia, infection-related length of stay, infection-related 90-day readmission, 30-day all-cause mortality and adverse events necessitating a change in therapy. Of 89 patients with MSSA bacteremia included, 29 received DAP, 30 received NAF, and 30 received CFZ. There was no difference in the composite primary outcome in patients treated with DAP compared to ASBL (10% versus 5%, p=0.39). The DAP cohort had a longer hospital length of stay compared to the ASBL group (20 days versus 11.5 days, p=0.0007). No differences were detected between other secondary outcomes. This study suggests DAP may serve as a comparable alternative to ASBLs for treatment of MSSA bacteremia as no differences in clinical outcomes were identified. Larger studies are needed to confirm these findings.

PMID:34033912 | DOI:10.1016/j.ijantimicag.2021.106363

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