Abstract

BackgroundResistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates have been reported when vancomycin was used. The purpose of this study was to assess the clinical dosage, effect, and safety of daptomycin in patients with resistant staphylococcal PJI.MethodsWe retrospectively enrolled patients with hip or knee PJI who were treated with daptomycin in our institution (n = 16) from January 2013 to December 2014 with a minimum follow-up of 2 years. The patients received daptomycin when glycopeptide could not be used due to multiple resistance, any adverse reaction, chronic kidney disease stage 3 or worse, and previous treatment failure with glycopeptide or empirical therapy.ResultsThese patients received daptomycin at a median dose of 8.3 mg∕kg per day for a median duration of 14 days. The overall treatment success rate was 87.5% (14 of 16 cases) after a median follow-up period of 27 months. In the subgroups of acute and chronic PJI, the success rate was 80% and 91%, respectively. One patient developed asymptomatic transient serum aspartate transaminase (AST) elevation. No severe side effects such as myositis, acute renal failure due to rhabdomyolysis or eosinophilic pneumonia were found in our series.ConclusionRelatively high daptomycin doses combined with adequate surgical intervention were effective in treating resistant staphylococcal PJI. Daptomycin is an option worthy of consideration in PJI patients for whom glycopeptide treatment is unsuitable. Further prospective randomized comparative study is needed in the future.

Highlights

  • Resistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI)

  • The pathogenesis of PJI is mainly attributable to the formation of a biofilm caused by microorganisms attaching to the surface of the involved prosthesis, the biofilm being resistant to host defences and antimicrobial agents [3]

  • Patients with resistant staphylococcal PJI are often treated with a glycopeptide such as

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Summary

Introduction

Resistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI). Periprosthetic joint infection (PJI) is a serious complication related to significant morbidity, mortality, and medical costs [1]. The incidence of PJI has been reported to be around 0.5% to 1.0% for hip replacement cases and 0.5% to 2% for knee replacements [2]. The pathogenesis of PJI is mainly attributable to the formation of a biofilm caused by microorganisms attaching to the surface of the involved prosthesis, the biofilm being resistant to host defences and antimicrobial agents [3]. The incidence rate of PJI caused by methicillin-resistant Staphylococci is a rising concern [9]. Patients with resistant staphylococcal PJI are often treated with a glycopeptide such as

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