PURPOSE: Daptomycin (DAP) has proven utility in the treatment of complicated skin and skin structure infections and bacteremia caused by certain aerobic Gram-positive organisms (GPC). We have used this drug successfully for these types of infections,and hypothesize that DAP may also be useful in the treatment of NSTI's.
METHODS: This study was a subset analysis of a retrospective review of all patients that had received DAP during the period of January 01, 2005 - June 20, 2007. Data collected determined whether treatment was given for wounds infected with specific organisms, empirically, or for bacteremia and whether each case was considered a treatment success or failure. 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 different organisms needing some other type of anti-infective such as Gram-negative organisms or fungal species. Microbiological cure was defined as a positive culture at treatment onset, followed by a negative culture upon discharge or discontinuation of therapy.
RESULTS: Twenty two patients were diagnosed with an NSTI, 7 females, 15 males, mean age of 51 years old. GPC organisms cultured included MRSA (9), MSSA (5), Streptococci (6) and Enterococci (2). Eight of these cases also presented with a GPC bacteremia. The complexity of this population was demonstrated by their multiple co-morbidities including diabetes mellitus (9), hypertension (5), renal dysfunction/failure (4). Microbiological cure and presumed eradication by clinical response to treatment was 100% following a mean 21 days of intravenous antibiotics. Final disposition of patients revealed that one patient (4.5%) expired due to other co-morbid conditions unrelated to the NSTI, while the remaining 21 (95.5%) were discharged home or appropriate venues.
CONCLUSION: In our center, patients with NSTI's predominantly caused by Gram-positive organisms presented complex management issues, were critically ill, had a significant number of associated bacteremias and had an increase risk of mortality.
CLINICAL IMPLICATIONS: Daptomycin (DAP) use contributed to a robust success rate in these complex patients.
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.