1732. Effectiveness of Daptomycin (D) for MRSA Bloodstream Infections (BSI) with Vancomycin (V) MIC 1.5-2.0 mg/L: A Multi-center Evaluation of Clinical and Microbiological Outcomes
Session: Poster Abstract Session: Treatment of Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek_DAP_Clinical_Micro_Poster_10-5-2013.pdf (103.6 kB)
  • Background: Despite mounting evidence that V efficacy declines for treatment of MRSA BSI with V MIC > 1, clinical studies examining optimal antimicrobial therapy for these patients are limited. Few multicenter investigations have been performed to establish the efficacy of D for this indication.

    Methods: Multicenter, retrospective study, examining clinical & microbiological outcomes of D, when used as initial or early therapy (≤5 d prior V) in MRSA BSI with V MIC 1.5-2.0. Overall failure included: 60-d all-cause mortality, 7-d persistence, discontinue for failure or adverse event, 30-d relapse.

    Results: 93 D-treated cases from 11 US institutions were enrolled (2007-2012). Median (IQR) age was 61 (50-77); APACHE II was 14 (10-18); 90% had ID consult; 77% had echocardiogram. Clinical features: ICU stay (30%), dialysis (23%), immunocompromised (19%), cancer (16%). V MICs were 1.5 & 2.0 for 32% & 68%, respectively. 54% received ≤2 d prior V; 17% received no prior V. Most common BSI focus: bone/joint (30%), endocarditis (IE) (23%), skin (20%), unknown source (15%). Median D dose: 6 mg/kg (range, 6-10). The majority (79%) cleared bacteremia by d 4: 58% of IE, 67% of mycotic aneurysm/ septic thrombophlebitis, 69% of unknown source, 80% of catheter, 88% bone/joint, 94% skin & 100% abdominal/urinary. Overall unadjusted failure was 30% (28/93): 18% due to 60-d all cause mortality, 10% for lack of MRSA clearance by d 7, 3% switched to alternative for D failure. No recurrence was noted. Some had >1 failure reason. 30- & 60-d all cause mortality was 10% (9/93) & 18% (17/93), respectively. 60-d mortality, attributable to MRSA, occurred in 3% (3/93). Logistic regression identified 60-d all-cause mortality to be associated with ICU stay (OR, 4.43 [95% CI, 1.39-14.2]; p=0.012) & increased age (OR, 1.04 [95% CI, 1.00-1.07]; p=0.038). No relationship was noted between time to bacteremia clearance (by 4 & 7 d, respectively) & 60-d mortality (p=0.204 & p=0.468, respectively).

    Conclusion: MRSA bacteremia is a heterogeneous disease with different rates of response to antimicrobial therapy based on the primary focus of infection. Patient mortality was related to severity of illness (ICU stay) & advanced age. In this multicenter study, D therapy appears to be an option in MRSA BSI with V MIC 1.5-2.

    Pamela A. Moise, PharmD1, Darren L. Culshaw, PharmD1, Annie Wong-Beringer, PharmD2, Joyce Bensman, PharmD2, Kenneth Lamp, PharmD1, Winter J. Smith, PharmD3, Karri Bauer, PharmD4, Debra A. Goff, PharmD4, Robert Adamson, PharmD5, Kimberly Leuthner, PharmD6, Michael Virata, MD7, James A. Mckinnell, MD8, Saira B. Chaudhry, PharmD, MPH9, Romic Eskandarian, PharmD10, Thomas Lodise, PharmD11 and Marcus Zervos, MD12, (1)Cubist Pharmaceuticals, Lexington, MA, (2)University of Southern California, Los Angeles, CA, (3)University of Oklahoma Health Sciences Center, Oklahoma City, OK, (4)The Ohio State University Medical Center, Columbus, OH, (5)St. Barnabas Health Care System, Livingston, NJ, (6)University Medical Center of Southern Nevada, Las Vegas, NV, (7)Infectious Diseases, Yale-New Haven Hospital-SRC, New Haven, CT, (8)Torrance Memorial & Harbor-UCLA, Torrance, CA, (9)Jersey Shore University Medical Center and Rutgers University, Neptune, NJ, (10)Glendale Adventist Medical Center, Glendale, CA, (11)Albany College of Pharmacy, Albany, NY, (12)Infectious Diseases, Henry Ford Hospital, Detroit, MI

    Disclosures:

    P. A. Moise, Cubist Pharmaceuticals: Employee and Shareholder, Salary

    D. L. Culshaw, Cubist Pharmaceuticals: Employee and Shareholder, Salary

    A. Wong-Beringer, Cubist Pharmaceuticals: Investigator, Research support

    J. Bensman, None

    K. Lamp, Cubist: Employee and Shareholder, Salary

    W. J. Smith, Cubist Pharmaceuticals: Investigator, Research support

    K. Bauer, Cubist Pharmaceuticals: Investigator, Research support

    D. A. Goff, Cubist Pharmaceuticals: Investigator, Research support

    R. Adamson, Cubist Pharmaceuticals: Investigator, Research support

    K. Leuthner, Cubist Pharmaceuticals: Investigator, Research support

    M. Virata, Cubist Pharmaceuticals: Investigator, Research support

    J. A. Mckinnell, Cubist Pharmaceuticals: Investigator, Research support

    S. B. Chaudhry, Cubist Pharmaceuticals: Investigator, Research support

    R. Eskandarian, Cubist Pharmaceuticals: Investigator, Research support

    T. Lodise, Cubist Pharmaceuticals: Consultant, Consulting fee

    M. Zervos, Cubist Pharmaceuticals: Investigator, Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.