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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Daptomycin therapy for invasive Gram-positive bacterial infections in children
Monica I Ardura1, Asunción Mejías, Kathy S Katz
1Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Medical Center Dallas, Dallas, TX 75390-9063, USA. monica.ardura@utsouthwestern.edu
Background:
Clinical improvement is often delayed among children with invasive infections caused by multidrug resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) despite use of standard antimicrobial therapy. Daptomycin, a bactericidal lipopeptide antibiotic, may prove useful for treatment of these infections in children, but clinical experience is lacking.
Methods:
Retrospective review of medical records of hospitalized children who received daptomycin for treatment of invasive Gram-positive bacterial infections at Children's Medical Center Dallas from December 2003 to March 2007. Bacterial isolates were tested for susceptibility to daptomycin and characterized by pulsed-field gel electrophoresis and polymerase chain reaction for staphylococcal cassette chromosome mec A.
Results:
Sixteen children (10 male; median age, 6.5 years) received daptomycin. Fifteen (94%) children had invasive staphylococcal disease (14, MRSA, of which 13 were community-associated; 1, methicillin-susceptible S. aureus), and 1 had urinary tract infection caused by VRE. Twelve children with disseminated staphylococcal disease had bacteremia for 2-10 days despite therapy with 2 or more of the following: vancomycin, clindamycin, rifampin, aminoglycoside, or linezolid. The addition of daptomycin resulted in bacteriologic cure in 6 of 7 evaluable patients with persistent bacteremia. No adverse events were attributed to daptomycin. Overall, 14 patients improved and were discharged home, and 2 died of complications of their underlying medical conditions.
Conclusions:
The majority of patients demonstrated clinical improvement after addition of daptomycin to conventional antimicrobial therapy. Further studies are needed to assess the pharmacokinetics, pharmacodynamics, safety, and effectiveness of daptomycin in infants and children.
Insights
Daptomycin shows promise in treating invasive infections in children caused by multidrug-resistant bacteria like MRSA and VRE. Adding daptomycin to standard therapy improved outcomes for most pediatric patients with these difficult-to-treat infections.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Therapy
- Bacterial Pathogenesis
Background:
- Invasive infections in children caused by multidrug-resistant Gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), often show delayed clinical improvement with standard antimicrobial therapy.
- Daptomycin, a bactericidal lipopeptide antibiotic, presents a potential treatment option for these pediatric infections, but clinical data is limited.
Purpose of the Study:
- To evaluate the safety and effectiveness of daptomycin in treating invasive Gram-positive bacterial infections in hospitalized children.
- To assess the clinical outcomes of pediatric patients receiving daptomycin for infections caused by MRSA and VRE.
Main Methods:
- A retrospective review of medical records was conducted for children hospitalized between December 2003 and March 2007 who received daptomycin for invasive Gram-positive bacterial infections.
- Bacterial isolates were tested for daptomycin susceptibility. Molecular methods, including pulsed-field gel electrophoresis and PCR, were used to characterize staphylococcal cassette chromosome mec A.
Main Results:
- Sixteen children received daptomycin for invasive infections, predominantly MRSA (14 patients) and VRE (1 patient).
- Twelve children had persistent bacteremia despite multiple prior antimicrobial agents. Daptomycin addition led to bacteriologic cure in 6 of 7 evaluable patients with persistent bacteremia.
- Fourteen patients showed clinical improvement and were discharged; no adverse events were attributed to daptomycin.
Conclusions:
- The addition of daptomycin to conventional antimicrobial therapy resulted in clinical improvement for the majority of pediatric patients with invasive Gram-positive bacterial infections.
- Further research is warranted to fully elucidate the pharmacokinetics, pharmacodynamics, safety, and efficacy of daptomycin in pediatric populations, including infants.
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