Daptomycin for the treatment of surgical site infections

Abstract

The increasing frequency of methicillin-resistant Staphylococcus aureus (MRSA) as a cause of surgical site infections, and decreased susceptibility to vancomycin, highlight the need for alternative therapies. All patients with a surgical site infection enrolled in the Cubicin Outcomes Registry and Experience (CORE 2007 retrospective multicenter registry were studied. Outcome was assessed at the end of daptomycin therapy using protocol-defined criteria. Success was defined as cured or improved. Non-evaluable patients were excluded from the efficacy analysis but were included in the safety analysis. Of 962 patients in the CORE registry in 2007, 104 (11%) had a surgical infection and met the criteria for the efficacy analysis. The overall success rate was 91% (95/104). The distribution of surgical site infections by depth was 36% (38/104) superficial incisional, 36% (38/104) deep incisional, and 27% (28/104) organ/space. Success rates by infection depth were 92% for superficial incisional, 92% deep incisional, and 89% organ/space (P = .9). Success in patients with and without surgery was 89% (49/55) and 94% (46/49) (P = .5). The median final daptomycin dose was 5.5 mg/kg. The median duration of daptomycin therapy was 14 days. Prior antibiotic therapy was given to 79% of patients; 35% failed. Prior vancomycin was used in 45% of patients; 24% failed. Among vancomycin failures, the daptomycin success rate was 91% (10/11). Of those with a positive culture, common pathogens were S. aureus (68%; MRSA 61%) and enterococci (26%; vancomycin-resistant 36%). There were 9 possible treatment-related adverse events (AEs) in 8 of 118 (7%) patients; 2 serious AEs were reported in 1 patient. Success rates for patients with a surgical site infection treated with daptomycin were high and did not differ based on the need for surgical intervention. High success rates were achieved in patients with infection caused by MRSA as well as in patients who had failed to respond to previous antibiotic therapies, including vancomycin, regardless of the depth of the infection.