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Daptomycin treatment in patients with resistant staphylococcal periprosthetic joint infection
Yu-Jui Chang1, Mel S Lee1,2, Chen-Hsiang Lee2,3
1Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.
Background:
Resistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates have been reported when vancomycin was used. The purpose of this study was to assess the clinical dosage, effect, and safety of daptomycin in patients with resistant staphylococcal PJI.
Methods:
We retrospectively enrolled patients with hip or knee PJI who were treated with daptomycin in our institution (n = 16) from January 2013 to December 2014 with a minimum follow-up of 2 years. The patients received daptomycin when glycopeptide could not be used due to multiple resistance, any adverse reaction, chronic kidney disease stage 3 or worse, and previous treatment failure with glycopeptide or empirical therapy.
Results:
These patients received daptomycin at a median dose of 8.3 mg∕kg per day for a median duration of 14 days. The overall treatment success rate was 87.5% (14 of 16 cases) after a median follow-up period of 27 months. In the subgroups of acute and chronic PJI, the success rate was 80% and 91%, respectively. One patient developed asymptomatic transient serum aspartate transaminase (AST) elevation. No severe side effects such as myositis, acute renal failure due to rhabdomyolysis or eosinophilic pneumonia were found in our series.
Conclusion:
Relatively high daptomycin doses combined with adequate surgical intervention were effective in treating resistant staphylococcal PJI. Daptomycin is an option worthy of consideration in PJI patients for whom glycopeptide treatment is unsuitable. Further prospective randomized comparative study is needed in the future.
Insights
Daptomycin effectively treated resistant staphylococcal periprosthetic joint infections (PJI) in 87.5% of patients when vancomycin failed or was contraindicated. This antibiotic is a viable option for complex PJI cases.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Resistant staphylococcal infections pose significant challenges in treating periprosthetic joint infections (PJI).
- Vancomycin use in PJI has been associated with higher failure rates.
- Alternative treatments are crucial for patients with resistant PJI.
Purpose of the Study:
- To evaluate the clinical dosage, efficacy, and safety of daptomycin for resistant staphylococcal PJI.
- To assess daptomycin as a treatment option when glycopeptides are unsuitable.
- To analyze treatment outcomes in patients with hip or knee PJI.
Main Methods:
- Retrospective study of 16 patients with hip or knee PJI treated with daptomycin (January 2013 - December 2014).
- Daptomycin was administered when glycopeptides were contraindicated (resistance, adverse reactions, CKD) or failed.
- Minimum follow-up of 2 years was required.
Main Results:
- Median daptomycin dose was 8.3 mg/kg/day for 14 days.
- Overall treatment success rate was 87.5% (14/16 patients) at a median follow-up of 27 months.
- Acute PJI success rate was 80%, chronic PJI success rate was 91%.
- One patient had transient AST elevation; no severe side effects like myositis or rhabdomyolysis were observed.
Conclusions:
- High-dose daptomycin, combined with surgery, is effective for resistant staphylococcal PJI.
- Daptomycin presents a valuable alternative for PJI patients unsuitable for glycopeptide therapy.
- Further prospective studies are warranted to confirm these findings.
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