Daptomycin therapy for gram-positive infections in cancer patients

Abstract

8193 Background: Daptomycin is a novel cyclic lipopeptide antibacterial agent approved for the treatment of skin and skin structure infections caused by susceptible gram-positive organisms. Clinical data in cancer patients are limited. Methods: Retrospective review of daptomycin usage for documented and/or suspected gram-positive infections in cancer patients at a comprehensive cancer center. Results: Twenty-one patients, 9 men and 12 women, were treated. Five (21%) patients received 6 mg/kg/day and 16 patients received 4 mg/kg/day. Eleven (52%) had hematological malignancies and 10 (48%) had solid tumors (acute leukemia, lymphoma and breast cancer were the most common). The average age was 49 years (range 27–56). Six (29%) were neutropenic. The infections treated were cellulitis-12 (57%), abscess-3 (14%), bacteremia-5 (24%), and urinary tract infection-1 (5%). The organisms isolated were S. aureus (8, including 4 MRSA), Enterococcus spp. (4, including 2 VRE), and coagulase negative staphylococci- (3). Five patients (24%) had failed vancomycin (3 cellulitis, 2 bacteremia) and 2 linezolid therapy (l cellulitis, 1VRE bacteremia). All isolates from clinical failures were susceptible to prior antimicrobial regimens. The overall response to daptomycin (19 of 21 patients) was 90%. Five of the six neutropenic patients responded to daptomycin therapy. The mean duration of therapy was 11 days. No toxicity was observed, including no CPK elevations. The 2 patients who failed to respond to daptomycin (both leukemics with cellulitis/abscess) responded to alternative agents. Conclusions: Daptomycin appears to be a promising agent for the treatment of gram-positive infections in neutropenic and non-neutropenic cancer patients and needs further clinical evaluation in this setting. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Cubicin Cubicin