Daptomycin for the treatment of gram-positive bacteremia and infective endocarditis: A retrospective case series of 31 patients

Study Objective. To evaluate the outcomes in patients with bacteremia and/or infective endocarditis who were treated with daptomycin. Design. Retrospective chart review. Setting. A university-affiliated medical center in Chicago, Illinois, and a regional hospital in Fountain Valley, California. Patients. Thirty-one inpatients treated with daptomycin for bacteremia and/or infective endocarditis. Measurements and Main Results. Patients were given daptomycin 4-6 mg/kg intravenously every 24-48 hours based on the practitioner's discretion and depending on the patient's clinical condition and presence of comorbidities. Primary end points were resolution of signs and symptoms of infection and discharge from the hospital. Methicillin-resistant Staphylococcus aureus ([MRSA] 11 patients) and vancomycin-resistant entercocci ([VRE] 11 patients) were the most common pathogens, whereas 7 patients had methicillin-sensitive S. aureus infection and 1 patient had coagulase-negative Staphylococcus infection. One patient with endocarditis had a negative culture result. Overall, 24 (77%) of the 31 patients achieved clinical resolution and were discharged, including all patients infected with MRSA; 7 patients died, 6 of whom had VRE infection. Duration of treatment for infective endocarditis lasted longer (typically 22-43 days) than that for bacteremia only (<= 14 days), and no patients discontinued daptomycin because of adverse events. Conclusion. In these patients, daptomycin was safe and well tolerated even for extended durations of treatment. Daptomycin may provide an effective option for treating drug-resistant gram-positive bloodstream infections and endocarditis.