1042. Daptomycin for the treatment of SSTI, is there opportunity for antimicrobial stewardship intervention?
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Concern for MRSA as a causative pathogen of skin and skin structure infections (SSTIs) has prompted clinicians to increasingly prescribe anti-MRSA therapy for this condition. But, a recent study showed no benefit with anti-MRSA therapy in non-purulent cellulitis. We aimed to characterize patients admitted for SSTI and prescribed daptomycin (DAP) at a community teaching hospital in order to identify areas for improvement in use.

Methods: Medical records of patients receiving DAP with a principle diagnosis of skin and soft tissue infections (SSTI) during 2012 were analyzed for relevant demographic, laboratory, and clinical data. Daptomycin use was restricted to 1) treatment of gram (+) organisms and 2) intolerance to vancomycin or linezolid. Risk factors (RF) for MRSA in SSTI were defined as having antibiotic use within the past 6month, presence of purulent drainage or exudates and no response to BL therapy.

Results: 69 pts received DAP for SSTI. Median age was 65 (53.5, 83.5), 39 (56.5%) were male. Of the 61 pts criteria for use; reasons for DAP therapy were renal insufficiency (30), clinical worsening of cellulitis (17), intolerance to vancomycin or linezolid (11), obesity (4). Most patients were afebrile (36.9), without elevated WBC (8.55 (6.7, 11.6)) and were able to tolerate PO diet and medications (59 (96.7%)). The majority of patients did not meet SIRS criteria (50 (82%)) nor required pressors (59 (96.7%). Daptomycin at 396.7mg average daily dose was prescribed as empiric therapy in the majority of pts (42 (89.4%) with culture negative for MRSA. Of the pts with RF (n=53) for MRSA, there were more pts with positive wound culture vs pts with no RF (n=8) (27 (50.9%) vs 1 (12.5%), p=0.059). 14 (22.9%) pts had MRSA positive wound culture. Presence of pus or exudates were more common in pts with culture positive for MRSA (8 (57.1%) vs. 11 (23.4%), p=0.024), consistent with the higher proportion of patients who received a procedure to treat the infection (8 (57.1%) vs. 13 (27.6%), p=0.057).  

Conclusion: Majority of patients who received daptomycin for SSTI did not have MRSA positive wound cultures, were clinically stable and tolerated PO intake. Continuation of DAP despite negative culture and oral intake incurs unnecessary healthcare resource utilization and promotes resistance from overuse

M. Tuan Tran, PharmD, Huntington Hospital, Pasadena, CA; University of Southern California, pasadena, CA, Joyce Ho, BA, University of Southern California, los angeles, CA and Annie Wong-Beringer, PharmD, Huntington Hosp, Los Angeles, CA

Disclosures:

M. T. Tran, None

J. Ho, None

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

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