JAC Advance Access published online on November 13, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm437
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Outcomes with daptomycin versus standard therapy for osteoarticular infections associated with Staphylococcus aureus bacteraemia
1 Division of Infectious Diseases, Duke Clinical Research Institute, Durham, NC, USA 2 Division of Geographic Medicine and Infectious Diseases, Tufts New England Medical Center, Boston, MA, USA 3 Johns Hopkins University School of Medicine, Baltimore, MD, USA 4 Cubist Pharmaceuticals, Lexington, MA, USA 5 Independent Consultant, Newton, MA, USA 6 Drexel University College of Medicine, Philadelphia, PA, USA 7 Wayne State University School of Medicine, Detroit, MI, USA 8 Denver Health Medical, Denver, CO, USA 9 Cleveland Clinic, Cleveland, OH, USA 10 Beth Israel Deaconess Medical Center, Boston, MA, USA
Received 25 July 2007; returned 27 August 2007; revised 11 October 2007; accepted 12 October 2007
* Corresponding author. Tel: +1-919-668-8077; Fax: +1-919-668-7103; E-mail: lalan002{at}mc.duke.edu
Objectives: To evaluate the clinical characteristics, treatment and outcomes of patients with osteoarticular infections (OAIs) associated with Staphylococcus aureus bacteraemia (SAB).
Methods: The clinical characteristics and outcomes for patients with OAI were described using a post hoc analysis of an open label, randomized trial comparing daptomycin with standard therapy (vancomycin or anti-staphylococcal penicillin with initial gentamicin) for the treatment of SAB.
Results: OAI occurred in 32 of 121 patients (21 daptomycin and 11 standard therapy) with complicated SAB (18 septic arthritis, 9 vertebral osteomyelitis and 7 others). Two patients had osteomyelitis in more than one site. Success rates seen in two groups were as follows: vertebral osteomyelitis [3/5 (60%) daptomycin versus 0/2 (0%) comparator], septic arthritis [7/11 (64%) versus 3/5 (60%)], sternal osteomyelitis [3/3 (100%) versus 1/2 (50%)] and long bone osteomyelitis [0/1 (0%) versus 1/1 (100%)]. Success rates in both treatment groups improved with surgical therapy. Creatine phosphokinase elevations to >500 IU/L occurred in one patient on daptomycin who discontinued therapy, whereas renal impairment developed in three patients on standard therapy, two of whom discontinued therapy. Two patients treated with daptomycin and one patient on vancomycin had increases in S. aureus MICs to daptomycin and vancomycin, respectively. Three patients treated with daptomycin died following completion of therapy, with mortality attributed to multiple co-morbid conditions and inadequate debridement of OAIs in these patients. No deaths were reported in the standard therapy group.
Conclusions: Daptomycin may be considered an alternative to standard therapy in the treatment of patients with complicated SAB and OAI.
Key Words: osteomyelitis , septic arthritis , complicated bacteraemia , treatment
Deceased—please see the Acknowledgements section.
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