Evaluation Of The Use Of Daptomycin In Diabetic Foot Infections With Osteomyelitis

Abstract

Background: Daptomycin has shown efficacy in patients with diabetes in skin and skin structure infections caused by Grampositive pathogens. However, data are limited in patients with osteomyelitis. This study evaluated the safety and clinical response rate of patients treated with daptomycin for moderate to severe diabetic foot infections with osteomyelitis. Methods: This was a retrospective, multicenter study. Standardized case report forms were used to collect available data on each patient. A clinical response of; cure, improvement, failure, clinical relapse, or non-evaluable and microbiologic outcomes of; eradication, presumed eradication, persistence, or presumed persistence was determined by each investigator. Information on adverse events was collected throughout the entire study. Results: Twenty-one patients were identified from 2 clinics in the United States. Patients received a mean daptomycin dose of 6.1 ± 0.4 mg/kg (range, 5.7–7.2 mg/kg) administered every 24 hours. The mean length of outpatient therapy was 28.9 ± 15.3 days (range, 9 to 57 days). The clinical success rate was 81.0% (17/21) at the end of therapy, and the overall clinical success rate ≥10 months following daptomycin therapy was 71.4% (15/21). The adverse event rate requiring daptomycin discontinuation was 4.8%. Three patients experienced adverse events possibly related to daptomycin. Two patients had elevated creatine phosphokinase, 1 to 2 times the upper limit of normal, and one patient had elevated hepatic enzymes. Conclusions: In this study, successful outcomes in patients with moderate to severe diabetic foot infections caused by Gram-positive pathogens suggest that daptomycin has a role for treating these complex infections.