Institutional Experience with Daptomycin Treatment in Patients with Gram-Positive Infections

Abstract

Purpose Daptomycin was originally approved for the treatment of complicated skin and skin-structure infections caused by gram-positive bacteria, and recently, its indications were expanded to include bacteremia and right-sided infective endocarditis caused by Staphylococcus aureus. This retrospective chart review examines outcomes and costs for individuals treated with daptomycin at a tertiary care medical center. Methods During an 11-month period, records of patients treated with daptomycin at the institution were reviewed. Cases for which complete cost data were available were included in the analysis. Outcomes were assigned to 4 categories: cured, improved, failed, or unevaluable. Hospital stay details were recorded, and antibiotic and total hospital treatment costs were calculated. Results Thirty-five patients representing 37 cases were included in the review. Of those cases, 89% (33 of 37) involved documented infections with gram-positive bacteria, 22% involved confirmed methicillin-resistant S. aureus infections, and 32% involved confirmed vancomycin-resistant enterococcus infections. Most cases (27 of 37; 73%) involved infections with multiple bacterial isolates for which previous therapy had failed. Of all clinically evaluable cases, 54% were classified as cured and 42% as improved after daptomycin therapy. Median and mean ± standard deviation (SD) total cost of hospitalization were $46,730 and $111,604 ± $137,138, respectively. Overall median duration of therapy for all 37 cases was 14 days (range, 1 to 143; mean ± SD duration, 25.5 ± 32 days). Conclusion Daptomycin cured or improved most evaluable gram-positive infections. The results of this study suggest that daptomycin may be considered a therapeutic option for treatment of drug-resistant gram-positive infections.