L-1506. Clinical Experience with Daptomycin Monotherapy for Osteomyelitis, Pace-Maker(PM)/Implantable Cardiac Defibrillator (ICD) Infections and Endocarditis
Session: Poster Session: Current Issues in Osteomyelitis
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Daptomycin (Dapto) may be a valuable option for the treatment of bloodstream infections related to intravascular devices and for bone and joint infections. Methods: We retrospectively evaluated 19 patients treated with D at Pisa tertiary care-university Hospital in the period from April 2007 to April 2008. Age, gender, type of infection, microorganism, daily dose of Dapto, days of treatment, adverse events and outcome were reviewed. Outcome were defined as failure, improvement or healing.
Results: Mean age ± SD was 57 ± 24 years, 17 patients were male. Seven patients had osteomyelitis (2 spondilodiscitis), 6 patients had S. aureus endocarditis, (3 patients with associated PM/ICD infection, 2 of these with embolic pneumonia), 4 patients had local PM/ICD infections, 2 patients had enterococcal endocarditis. The causative microorganism were: 6 MRSA, 5 MSSA, 5 CNS, 1 VRE, 1 E. faecalis, 1 Propionibacterium spp. Mean Dapto dose ± SD was 6,5 ± 0,6 mg/Kg/die. Mean treatment duration ± SD was 25 ± 6 days. All patients with osteomyelitis were cured. All S. aureus endocarditis were cured, including 3 endocarditis related to PM/ICD treated with transvenous removal of the device (2 pts with negative cultures of the leads). The 4 patients with local PM/ICD infections were also cured with antibiotic therapy and device removal. In all patients with PM/ICD infections a new device was implanted 48 hours after the removal of the infected one, during Dapto therapy, without relapse of infection. None of the treated patients experienced adverse events. The 2 patients with enterococcal endocarditis failed, having persistent positive blood cultures during Dapto monotherapy. Conclusions: Dapto monotherapy might be an effective therapy in osteomyelitis, endocarditis due to S. aureus and infections related to PM/ICD with embolic pneumonia. Dapto may be inadequate monotherapy option for enterococcal endocarditis
Carlo Tascini1, Ezio Soldati, MD2, Francesco Menichetti3, Giulio Zucchelli, MD2, Maria Grazia Bongiorni, MD2, Roberta Doria, MD2 and  C. Tascini, None., (1)Azienda Ospedaliera Universitaria Pisana, Pisa, Italy, (2)Azienda Ospedaliera Universitaria Pisana, (3)Cisanello Hospital