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Purpose: Staphylococcus aureus bacteremia duration is often correlated with complications and outcome. Current guidelines recommend alternative treatment when MRSA have vancomycin MICs ≥ 2 mg/L. This analysis presents daptomycin (DAP) clinical outcomes by MRSA duration in the presence of elevated vancomycin MICs.
Methods: All patients (pts) with MRSA bacteremia (MRSA-B), excluding catheter-related, were identified from a retrospective, multicenter, observational registry with a vancomycin MICs of ≥ 1.5 mg/L. Definition of bacteremia duration: number of days between first and last positive blood culture or time until negative culture if within 3 days of index culture, all others were classified as unknown. Pt characteristics and outcomes are based on the efficacy population. All pts were included in the safety analysis.
Results: There were 97 pts with MRSA-B; 95 evaluable for outcomes (92/95 vancomycin MIC = 2 mg/L). Demographics: 48% male, 47% ≥ 65 years of age, 13% on dialysis, 22% received DAP treatment in the ICU, and 35% had severe sepsis. DAP median dose was 6 mg/kg in each MRSA-B duration group. Antibiotics prior to DAP were given in 72 pts (76%); primarily vancomycin (93%, 67/72). Concomitant antibiotics were used with DAP in 42 pts (44%) and was not different by bacteremia duration. The most frequent concurrent infections included endocarditis (13%), bone/joint infections (12%) and skin infections (11%). DAP median (min, max) duration of treatment was 11 days (2, 62). Success occurred in 88% (cured 43%, improved 45%). Success by bacteremia duration was: ≤ 1 d (100%, 3/3), >1 to <3 d (100%, 33/33), ≥ 3 d (92%, 11/12), and unknown (79%, 37/47). Serious adverse events were reported in 17 pts (18%); none were possibly-related to DAP. Two pts discontinued DAP due to adverse event. The overall mortality rate was 20% (19/97).
Conclusion: In this real-world population, DAP appeared to be a useful agent for MRSA with a VAN MIC ≥ 1.5 mg/L.