TY - JOUR
T1 - Efficacy and safety of daptomycin in the treatment of Gram-positive catheter-related bloodstream infections in cancer patients
AU - Chaftari, Anne Marie
AU - Hachem, Ray
AU - Mulanovich, Victor
AU - Chemaly, Roy F.
AU - Adachi, Javier
AU - Jacobson, Kalen
AU - Jiang, Ying
AU - Raad, Issam
N1 - Funding Information:
Funding : This study was supported by a grant from Cubist Pharmaceuticals.
Funding Information:
Competing interests : IR has received a research grant from Cubist. RFC is on the speaker's bureau for and has received a research grant (unrelated to this study) from Cubist. All other authors declare no competing interests.
PY - 2010/8
Y1 - 2010/8
N2 - Excessive vancomycin usage has contributed to the emergence of vancomycin-resistant enterococci, and a high vancomycin minimal inhibitory concentration (MIC) >1.0 μg/mL has been associated with poor outcome in patients with meticillin-resistant Staphylococcus aureus (MRSA) infection. In view of these limitations, there is a need for an alternative agent. We evaluated the clinical efficacy and safety of daptomycin given as an alternative agent in the treatment of Gram-positive catheter-related bloodstream infections (CRBSIs) in cancer patients. Between June 2006 and March 2008, 40 patients with probable or definite CRBSI caused by Gram-positive organisms were prospectively enrolled to receive daptomycin intravenous 6. mg/kg/day for up to 4 weeks. In addition, 40 historical matched control patients treated with vancomycin were retrospectively identified. The control group was matched based on underlying disease, organism and neutropenic status. The daptomycin group was comparable with the vancomycin group in terms of neutropenia rate, complications, adverse events, length of hospital stay and death. However, more patients in the daptomycin group achieved symptom resolution at 48. h compared with the vancomycin group (76% vs. 53%; P=0.04). Similarly, more patients in the daptomycin group achieved microbiological eradication at 48. h compared with the vancomycin group (78% vs. 34%; P<0.001). Although not significant, nephrotoxicity was almost three-fold lower in the daptomycin group. The overall response was significantly better for daptomycin compared with vancomycin (68% vs. 32%; P=0.003). In conclusion, compared with vancomycin, daptomycin treatment of Gram-positive CRBSI in cancer patients was significantly associated with earlier clinical and microbiological response as well as improved overall response.
AB - Excessive vancomycin usage has contributed to the emergence of vancomycin-resistant enterococci, and a high vancomycin minimal inhibitory concentration (MIC) >1.0 μg/mL has been associated with poor outcome in patients with meticillin-resistant Staphylococcus aureus (MRSA) infection. In view of these limitations, there is a need for an alternative agent. We evaluated the clinical efficacy and safety of daptomycin given as an alternative agent in the treatment of Gram-positive catheter-related bloodstream infections (CRBSIs) in cancer patients. Between June 2006 and March 2008, 40 patients with probable or definite CRBSI caused by Gram-positive organisms were prospectively enrolled to receive daptomycin intravenous 6. mg/kg/day for up to 4 weeks. In addition, 40 historical matched control patients treated with vancomycin were retrospectively identified. The control group was matched based on underlying disease, organism and neutropenic status. The daptomycin group was comparable with the vancomycin group in terms of neutropenia rate, complications, adverse events, length of hospital stay and death. However, more patients in the daptomycin group achieved symptom resolution at 48. h compared with the vancomycin group (76% vs. 53%; P=0.04). Similarly, more patients in the daptomycin group achieved microbiological eradication at 48. h compared with the vancomycin group (78% vs. 34%; P<0.001). Although not significant, nephrotoxicity was almost three-fold lower in the daptomycin group. The overall response was significantly better for daptomycin compared with vancomycin (68% vs. 32%; P=0.003). In conclusion, compared with vancomycin, daptomycin treatment of Gram-positive CRBSI in cancer patients was significantly associated with earlier clinical and microbiological response as well as improved overall response.
KW - Bloodstream infections
KW - Central venous catheters
KW - Gram-positive infections
KW - Immunocompromised patients
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U2 - 10.1016/j.ijantimicag.2010.03.015
DO - 10.1016/j.ijantimicag.2010.03.015
M3 - Article
C2 - 20452752
AN - SCOPUS:77953807287
SN - 0924-8579
VL - 36
SP - 182
EP - 186
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 2
ER -