Journal
CLINICAL INFECTIOUS DISEASES
Volume 56, Issue 11, Pages 1562-1569Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cit112
Keywords
vancomycin; daptomycin; methicillin-resistant Staphylococcus aureus; bacteremia
Categories
Funding
- Cubist
- Cerexa
- Clinical Therapeutics
- Forest
- National Institutes of Health
- Michigan Department of Community Health
- Pfizer
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Background. Recent reports have described decreased effectiveness with vancomycin treatment for methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) when the vancomycin minimum inhibitory concentration (MIC) is >1 mu g/mL. Methods. This matched, retrospective cohort study compared the clinical effectiveness of daptomycin with that of vancomycin for the treatment of MRSAB with vancomycin MICs >1 mu g/mL. The primary outcome was clinical failure, defined as a composite of 30-day mortality or bacteremia persisting for >= 7 days. Results. One hundred seventy patients were matched 1: 1 with respect to the antimicrobial administered. In the daptomycin group, all patients received <72 hours of vancomycin (median, 1.7 days [interquartile range, 1.1-2.3 days]) prior to switching to daptomycin. The rate of clinical failure at 30 days was significantly lower in the daptomycin arm compared to the vancomycin arm (20.0% vs 48.2%; P <0.001). Both 30-day mortality and persistent bacteremia were significantly lower in the daptomycin group compared to the vancomycin group (3.5% vs 12.9% [P =.047] and 18.8% vs 42.4% [P =.001], respectively). Logistic regression confirmed the association between vancomycin treatment and increased risk of clinical failure (adjusted odds ratio, 4.5; 95% confidence interval, 2.1-9.8). Conclusions. This is the first matched study comparing early daptomycin versus vancomycin for the treatment of MRSAB when the vancomycin MIC is >1 mu g/mL. Treatment with daptomycin resulted in significantly improved outcomes, including decreased 30-day mortality and persistent bacteremia. These results support the practice of switching early from vancomycin to daptomycin for the treatment of MRSAB when the vancomycin MIC is >1 mu g/mL.
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