Daptomycin therapy for osteomyelitis: a retrospective study.

Abstract

BACKGROUND:

Daptomycin is a rapidly bactericidal agent with broad coverage against Gram-positive organisms, including Staphylococcus aureus, the most frequent cause of osteomyelitis. The objective of this study was to describe the clinical outcome of patients with non-hardware associated osteomyelitis, and the safety profile of daptomycin in the treatment of these infections.

METHODS:

All patients with osteomyelitis, excluding concurrent orthopedic foreign body infections, treated with daptomycin and identified between 2007-2008 in a retrospective, multicenter, observational registry, were included. Investigators assessed patient outcome (cured, improved, failed, non-evaluable) at the end of daptomycin therapy. Patients with a successful outcome at the end of daptomycin therapy were reassessed in 2009. All patients were included in the safety analysis; evaluable patients were included in the efficacy analysis. Data was assessed using descriptive statistics. A Kaplan Meier analysis was used to assess time to clinical failure.

RESULTS:

Two-hundred and nine osteomyelitis patients successfully completed daptomycin therapy in 2007-2008, 71 of which (34%) had a follow-up visit in 2009 and had an evaluable clinical outcome. The median (min, max) daptomycin dose and duration were 6 mg/kg (4, 10) and 42 days (1, 88), respectively. Of the 52 patients with a documented pathogen, S. aureus was the most common (42%); primarily methicillin-resistant S. aureus. All patients were included in the safety analysis; evaluable patients were included in the efficacy analysis. Clinical resolution was reported in 94% (CI - 86.2%, 98.44%) of patients. A Kaplan Meier analysis of time to clinical failure showed that approximately 85% (CI - 64%, 95%) of patients had a continued successful outcome at the time of re-evaluation. Eighteen patients (25%) in the safety population experienced an adverse event; 13 patients (18%) had an adverse event that was possibly-related to daptomycin treatment.

CONCLUSIONS:

Daptomycin appears to be an effective therapeutic choice with an acceptable safety profile in the management of osteomyelitis that does not involve hardware.

• Authors: Jason C Gallagher, Jennifer A Huntington, Darren Culshaw, Scott A McConnell, Minjung Yoon, Elie Berbari
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 12 Pg. 133 (Jun 12 2012) ISSN: 1471-2334 [Electronic] England
• PMID: 22691420 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anti-Bacterial Agents
• Daptomycin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Daptomycin (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Osteomyelitis (drug therapy)
• Retrospective Studies
• Treatment Outcome