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Daptomycin versus vancomycin for complicated skin and skin structure infections: clinical and economic outcomes
Susan L Davis1, Peggy S McKinnon, Levi M Hall
1Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
Study Objective:
To assess the effect of daptomycin compared with vancomycin on the clinical and economic outcomes in patients with complicated skin and skin structure infections.
Design:
Prospective, open-label study.
Setting:
Level 1 trauma center in Detroit, Michigan.
Patients:
Fifty-three adult patients with complicated skin and skin structure infections at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection who were treated with daptomycin and a matched cohort of 212 patients treated with vancomycin.
Intervention:
Patients in the prospective arm received intravenous daptomycin 4 mg/kg every 24 hours for at least 3 days but not more than 14 days. Historical controls received at least 3 days of vancomycin dosed to achieve trough concentrations of 5-20 microg/ml.
Measurements And Main Results:
Outcomes evaluated included blinded assessments of clinical resolution, duration of therapy, and costs. The most common diagnoses were cellulitis (31%), abscess (22%), and both cellulitis with abscess (37%). Microbiology differed significantly between groups, with S. aureus found in 27 patients (51%) in the daptomycin group and 167 patients (79%) in the vancomycin group and MRSA in 22 (42%) and 159 (75%), respectively (p<0.001). The proportions of patients with clinical improvement or resolution of their infections on days 3 and 5 were 90% versus 70% and 98% versus 81% in the daptomycin versus vancomycin groups, respectively (p<0.01 for both comparisons), and 100% at the end of therapy in both groups. Among patients with complete resolution of their infections (41 patients [77%] with daptomycin vs 89 patients [42%] with vancomycin, p<0.05), median duration of intravenous therapy was 4 and 7 days, respectively, (p<0.001), and hospital costs were $5027 and $7552 (p<0.001).
Conclusions:
Patients receiving daptomycin achieved more rapid resolution of symptoms and clinical cure and had a decreased duration of inpatient therapy compared with those receiving vancomycin. This study suggests that daptomycin is a cost-effective alternative to vancomycin for complicated skin and skin structure infections.
Insights
Daptomycin demonstrated faster symptom resolution and clinical cure for complicated skin infections compared to vancomycin. This suggests daptomycin is a cost-effective alternative, reducing hospital stays and costs.
Area of Science:
- Infectious Diseases
- Pharmacoeconomics
- Clinical Medicine
Background:
- Complicated skin and skin structure infections (cSSSI) pose significant clinical and economic challenges.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in cSSSI, necessitating effective treatment options.
- Vancomycin is a standard treatment, but alternatives are being explored for improved outcomes and cost-effectiveness.
Purpose of the Study:
- To compare the clinical and economic outcomes of daptomycin versus vancomycin in patients with cSSSI.
- To evaluate the efficacy of daptomycin in achieving clinical resolution and reducing treatment duration.
- To assess the cost-effectiveness of daptomycin as a treatment for cSSSI.
Main Methods:
- A prospective, open-label study was conducted at a Level 1 trauma center.
- Fifty-three patients with cSSSI treated with daptomycin were compared to a matched cohort of 212 patients treated with vancomycin.
- Outcomes included clinical resolution, duration of intravenous therapy, and hospital costs.
Main Results:
- Daptomycin treatment resulted in significantly higher rates of clinical improvement and resolution by days 3 and 5 compared to vancomycin (90% vs. 70% and 98% vs. 81%, respectively).
- Patients receiving daptomycin experienced a shorter median duration of intravenous therapy (4 days vs. 7 days) and lower hospital costs ($5027 vs. $7552).
- Despite differences in baseline microbiology, including MRSA prevalence, daptomycin showed superior clinical outcomes.
Conclusions:
- Daptomycin promotes more rapid symptom resolution and clinical cure in patients with cSSSI compared to vancomycin.
- The findings suggest daptomycin is a cost-effective alternative, leading to decreased inpatient therapy duration and reduced healthcare expenditures.
- Daptomycin offers a viable treatment option for cSSSI, particularly in cases involving MRSA.
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