PURPOSE: Daptomycin has proven clinical utility in the treatment of complicated skin and skin structure infections caused by aerobic Gram positive bacteria. Its use in the treatment of wound coverage for specific organisms, adequate empirical coverage, and treatment of bacteremia has been successful in our unit.
METHODS: A retrospective chart review of patients that had received Daptomycin (DAP) from January 1, 2005 –June 20, 2007 was conducted. Treatment success or failure was based on therapeutic monitoring and treatment outcomes. Success for empiric coverage was deemed adequate if the condition improved, patient was discharged, or coverage with this agent was no longer warranted due to growth of organisms not covered in the spectrum of activity by DAP. Wound coverage was adequate if follow-up cultures returned as negative for the offending organism on original culture. Bacteremia was adequate if follow-up cultures returned as negative for the causative organism on follow-up culture.
RESULTS: 415 patients met criteria for evaluation. 157 patients were treated for a skin and skin soft tissue infection, 135 burn patients, 84 chronic wound, 22 necrotizing fasciitis, 9 Hidradenitis Suppurativa, 8 TENS, 1 Gas Gangrene, and 1 Pemphis vulgaris. 205 patients were treated for organism-specific coverage, 153 for empiric therapy, and 57 for bacteremia. Microbial response to treatment with Daptomycin was such that 361 patients had a presumed eradication and 52 definite eradications. Two patients had presumed persistence of originally cultured organisms. The clinical response was such that 405 patients were considered cured, 8 indeterminant, and 2 failures. No serious adverse events attributed to DAP were reported. One possibly-related adverse event of an elevated CPK level was reported which decreased after discontinuation of DAP.
CONCLUSION: Daptomycin use demonstrated a robust 97% success rate (cure plus improved) in complex and critically ill burn and complicated wound patients for the coverage of specific wound organisms, bacteremia, and empiric treatment across all wound types.
CLINICAL IMPLICATIONS: Daptomycin proved to be a reasonable choice for successful treatment of wound coverage, across all wound types.
DISCLOSURE: Bruce Friedman, Grant monies (from industry related sources) The Joseph M. Still Research Foundation, Inc. received an unrestricted educational grant from Cubist Pharmaceuticals in support of data collection for this study.; Consultant fee, speaker bureau, advisory committee, etc. The presenting author is an active member of the speakers’ bureau for Cubist Pharmaceuticals.; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. There is no approved indication for some of the applications for use with the drug in discussion. We have utilized this drug in an off-label manner and the outcomes are based on this use.