Emerging resistance and treatment failure associated with vancomycin for methicillin-resistant S. aureus (MRSA) and other resistant gram-positive organism such as vancomycin-resistant enterococcus (VRE) have led to increased use of daptomycin (DAP). Higher doses of DAP are increasingly selected, further escalating drug costs. Our DAP use is limited to patients with treatment failure, in vitro resistance, or vancomycin intolerance and requires antimicrobial stewardship pharmacist (ASP) review and infectious diseases consultation. The purpose of this review is to evaluate DAP use and the impact of ASP intervention on streamlining of DAP therapy.
All adult inpatients who received ≥ 24 hours of DAP between October 1, 2015 and April 30, 2016 were included. Patient demographics, DAP indication, dose, frequency, length of therapy, microbiological etiology and infection type, vancomycin minimum inhibitory concentration (MIC), DAP MIC, antibiotic therapy prior to DAP, and the appropriateness of DAP usage were evaluated. Data were analyzed by using descriptive statistics.
A total of 75 patients (median age of 64 years) were included and 23% were hemodialysis patients. Bacteremia occurred in 51% of patients. The most common sites of infections were skin soft tissue (17%) and osteoarticular (15%). Most common pathogens isolated were VRE (32%) and MRSA (23%). Majority of patients (91%) had appropriate indications for DAP therapy, most frequently for documented resistance (20%) and vancomycin allergy/intolerance (17%). DAP was initiated as empiric therapy in 35% and definitive therapy in 65% of patients. Furthermore, 35% patients were switched from DAP to alternative agents (ampicillin, vancomycin, linezolid, etc.). Median weight-based dosing (mg/kg) for Enterococcal and Staphylococcal bacteremia (IQR) were 7.0 (5.9 to 8.1) and 8.0 (7.4 to 8.7), respectively.
DAP therapy was prescribed based on appropriate indications in >90% of patients. ASP demonstrated a positive impact on streamlining 35% of patients to appropriate therapy. With 35% of patients on empiric DAP therapy, there are opportunities for ASP to de-escalate and optimize use.
B. N. Vu,
J. E. Williamson, None
Y. Guo, None
See more of: Poster Abstract Session