875. Daptomycin versus vancomycin for osteoarticular infections due to methicillin-resistant Staphylococcus aureus (MRSA): A case-control study
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • IDSA Dapto MRSA poster 15OCT12 FINAL SYL.pdf (199.9 kB)
  • Background: Vancomycin is the standard antibiotic for treatment of methicillin-resistant Staphylococcus aureus(MRSA) infections. While daptomycin is a proven alternative for treating MRSA bacteremia, its effectiveness in bone and joint infections has not been established. This study compares drug toxicity and clinical outcomes in patients (pts) receiving either daptomycin or vancomycin for MRSA bone and joint infections.

    Methods: 1:2 case-control study of adult pts admitted to Barnes-Jewish Hospital from 2005-2010 with a diagnosis of MRSA bone or joint infection identified through electronic medical records and confirmed by microbiology. We compared medical and surgical management and clinical outcomes (e.g., drug toxicity, cure) in pts treated with daptomycin or vancomycin.

    Results: 20 pts with MRSA bone and joint infection treated with daptomycin were identified and matched to 40 pts treated with vancomycin during the same time period. Median age was 52 years (range, 25-90), 40 (67%) were male, and 40 (67%) were white. Most patients had osteomyelitis (82%) and contiguous infection (87%). 40% were diabetics and 13% had renal insufficiency. Diabetic pts were more likely to have received vancomycin than daptomycin [20 (50%) vs. 4 (20%); p=0.03]. Vancomycin was more often part of an antibiotic combination regimen than daptomycin [22 (55%) vs. 5 (25%); p=0.03]. Median treatment duration was 48 days for daptomycin vs. 46 days for vancomycin (p=0.5). Pts receiving daptomycin underwent more surgeries than pts on vancomycin (1.8±0.8 vs. 1.4±0.6; p=0.04). Clinical success was achieved in 70% of all pts at 3 months and in 62% at 6 months after completing intravenous antibiotics. Clinical success rates were similar between daptomycin and vancomycin at 3 months [15 (83%) vs. 27 (84%); p=1.0] and 6 months [14 (87%) vs. 23 (79%); p=0.7]. The frequency of adverse events did not differ between treatment groups [1 (1%) vs.7 (18%); p=0.2].

    Conclusion: Daptomycin and vancomycin achieved similar rates of clinical success and drug tolerability in this small case-control study of patients with MRSA bone and joint infections. Daptomycin is a reasonable alternative to vancomycin for treating MRSA bone and joint infections.

    Stephen Liang, MD1, Hani Khair, MD2, Ellen Murray2, Hilary M. Babcock, MD, MPH2,3 and Jonas Marschall, MD4, (1)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Washington University School of Medicine, St. Louis, MO, (3)Division of Infectious Diseases, Washington University in St.Louis School of Medicine, St. Louis, MO, (4)Washington University School of Medicine, Saint Louis, MO

    Disclosures:

    S. Liang, WUSM KM1: Investigator, Educational grant

    H. Khair, None

    E. Murray, None

    H. M. Babcock, None

    J. Marschall, WUSM KL2 (CTSA): Investigator, Educational grant
    BJH ICTS: Grant Investigator, Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.