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Retrospective case-control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy
Authors:Falcone Marco  Russo Alessandro  Pompeo Maria Elena  Vena Antonio  Marruncheddu Laura  Ciccaglioni Antonio  Grossi Paolo  Mancini Carlo  Novelli Andrea  Stefani Stefania  Venditti Mario
Affiliation:a Department of Public Health and Infectious Diseases, Policlinico Umberto I, ‘Sapienza’ University of Rome, Viale dell’Università 37, 00161 Rome, Italy
b Department of Cardiovascular Diseases, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy
c Infectious and Tropical Diseases Unit, Department of Transplantation, University of Insubria-Ospedale di Circolo e Fondazione Macchi, Varese, Italy
d Department of Pharmacology, University of Florence, Florence, Italy
e Department of Pharmacology, University of Catania, Catania, Italy
Abstract:Glycopeptides have been considered the antimicrobials of choice for serious meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) infections for several years. Daptomycin is a new option for the treatment of these infections, including those exhibiting reduced susceptibility to glycopeptides. The aim of this study was to compare glycopeptides and daptomycin for the treatment of infections caused by MRSA or MR-CoNS. Data for 106 patients with bloodstream infections (bacteraemia or infective endocarditis) or skin and soft-tissue infections (SSTIs) were retrospectively reviewed, of which 43 were treated with daptomycin (DAP group) and 63 were treated with vancomycin or teicoplanin (GLYCO group). Patients included in the two comparison groups were homogeneous in terms of age, risk factors and clinical severity. Aetiology was mainly represented by MRSA in both groups, followed by various species of MR-CoNS. Daptomycin was used more frequently in patients with central venous catheter-associated bacteraemia or pacemaker-associated infection. Patients with SSTIs included in the GLYCO group had a longer mean duration of antibiotic therapy (18.2 days vs. 14.6 days; P = 0.009) and a longer mean length of hospital stay (28.2 days vs. 19.6 days; P = 0.01) compared with those included in the DAP group. A longer mean duration of antibiotic therapy was also observed in patients with bloodstream infections receiving glycopeptide therapy (25.6 days vs. 18 days; P = 0.004). In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting.
Keywords:Daptomycin   Vancomycin   Teicoplanin   Bloodstream infections   Skin and soft-tissue infections   Staphylococcus aureus   Coagulase-negative staphylococci
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