To assess the effect of daptomycin compared with vancomycin on the clinical and economic outcomes in patients with complicated skin and skin structure infections.
Prospective, open-label study.
Level 1 trauma center in Detroit, Michigan.
Fifty-three adult patients with complicated skin and skin structure infections at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection who were treated with daptomycin and a matched cohort of 212 patients treated with vancomycin.
Patients in the prospective arm received intravenous daptomycin 4 mg/kg every 24 hours for at least 3 days but not more than 14 days. Historical controls received at least 3 days of vancomycin dosed to achieve trough concentrations of 5-20 microg/ml.
Outcomes evaluated included blinded assessments of clinical resolution, duration of therapy, and costs. The most common diagnoses were cellulitis (31%), abscess (22%), and both cellulitis with abscess (37%). Microbiology differed significantly between groups, with S. aureus found in 27 patients (51%) in the daptomycin group and 167 patients (79%) in the vancomycin group and MRSA in 22 (42%) and 159 (75%), respectively (p<0.001). The proportions of patients with clinical improvement or resolution of their infections on days 3 and 5 were 90% versus 70% and 98% versus 81% in the daptomycin versus vancomycin groups, respectively (p<0.01 for both comparisons), and 100% at the end of therapy in both groups. Among patients with complete resolution of their infections (41 patients [77%] with daptomycin vs 89 patients [42%] with vancomycin, p<0.05), median duration of intravenous therapy was 4 and 7 days, respectively, (p<0.001), and hospital costs were $5027 and $7552 (p<0.001).
Patients receiving daptomycin achieved more rapid resolution of symptoms and clinical cure and had a decreased duration of inpatient therapy compared with those receiving vancomycin. This study suggests that daptomycin is a cost-effective alternative to vancomycin for complicated skin and skin structure infections.
"Multiple analyses have compared vancomycin (the incumbent “gold standard”) to linezolid and daptomycin. Though “suggestions” of superiority for daptomycin and/or linezolid have been found (van Hal and Paterson 2011;Bounthavong and Hsu 2012;Logman et al. 2010;Davis et al. 2007), the actual value with respect to hospital LOS from changing from initial therapy with vancomycin, a time tested and inexpensive antibiotic, to one of the more expensive newer agents as initial therapy for inpatient SSTIs have not been convincingly demonstrated. As part of a cost benefit analysis at our medical center, we conducted a retrospective study to evaluate the impact of initial inpatient antibiotic choice (daptomycin, linezolid, or vancomycin) on SSTI length of hospital stay. "
[Show abstract][Hide abstract] ABSTRACT: Empiric therapy of inpatient skin and soft tissue infections (SSTIs) generally require methicillin resistant Staphylococcus aureus (MRSA) coverage. Limited data are available to directly compare the effect of initial antibiotic choice on treatment outcomes and length of stay (LOS).
To assess potential differences in length of hospital stay when inpatients with complex skin and soft tissue infections (SSTIs) were initially treated with either vancomycin, linezolid, or daptomycin.
A retrospective review of 219 patients diagnosed with inpatient SSTI who received linezolid, vancomycin, or daptomycin for >48 hours was performed. Data collected included demographics, comorbidities, microbiologic/laboratory data, additional management (surgical, non-study antibiotics), hospital LOS, treatment outcome and morbidity/mortality.
The three groups evaluated were linezolid (n = 45), vancomycin (n = 90) daptomycin (n = 84). There was no difference between the three groups with respect to gender, age, comorbidities, leukocytosis, fever, antibiotics prior to admission, site of infection culture results and surgical intervention. One death was recorded, not associated with diagnosis of SSTI. No significant difference in LOS was found (P = 0.525) between the 3 groups. The mean LOS in entire cohort was 4.5 days (SD ± 2.5); thirty patients had prolonged LOS for non-SSTI reasons; reanalyzing the data without these 30 patients did not produce any difference in the mean LOS between the 3 groups. Switching vancomycin just prior to discharge to facilitate outpatient therapy was common but did not impact LOS.
No difference was detected in hospital length of stay with respect to the initial choice of antibiotic (linezolid, vancomycin, or daptomycin) for SSTI. The three antibiotic regimens were equally effective in treating SSTIs as judged by LOS, irrespective of age, gender, comorbidities or baseline severity of SSTI. Given the large standard deviation in LOS, this result should be confirmed by larger studies.
"Antibiotic therapy was left to the discretion of the prescribing physician; however, this choice could have been influenced by the presence of a criterion for linezolid use at this institution. Incision and drainage and/or debridement were not performed on these patients as this is consistent with previous cSSSIs trials previously completed  . Data collected included gender, age, weight, antibiotic allergies, dialysis status, hospital length of stay, additional therapies, and microbiological culture and susceptibility results. "
[Show abstract][Hide abstract] ABSTRACT: Objective. The objective of this analysis was to compare clinical and cost outcomes associated with patients who had suspected or documented methicillin-resistant Staphylococcus aureus (MRSA) infections treated with daptomycin, vancomycin, or linezolid in complicated skin and skin structure infections (cSSSIs). Design. This was a retrospective analysis conducted from February to June of 2007. Appropriate data was collected, collated, and subsequently evaluated with the purpose of quantifying length of stay, antibiotic therapy duration, clinical cure rates, adverse drug events, and cost of hospitalization. Results. All 82 patients included in the analysis experienced clinical cure. The duration of antibiotic therapy was similar among the three groups yet the length of hospitalization was slightly shorter in the daptomycin group. Conclusions. The incidence of resistant staphylococcal infections is increasing; therefore, judicious use of MRSA active agents is paramount. Future studies are necessary to determine if MRSA treatment options can be stratified based on the severity of the infectious process.
"The clinical and microbiological efficacy and safety of daptomycin were similar to those of commonly used comparator antibiotics for treating infected diabetic foot ulcers caused by Gram-positive pathogens. This was demonstrated in a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections.30 "
[Show abstract][Hide abstract] ABSTRACT: Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram-negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.
Vascular Health and Risk Management 11/2009; 5:949-63. DOI:10.2147/VHRM.S3162
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