Real-world daptomycin use with a focus on muscle toxicity: A multicentric retrospective study

Daptomycin is increasingly used to treat Gram-positive infections, but carries a risk of muscle toxicity. Despite guideline recommendations, real-world adherence to safety monitoring remains poorly documented.

To evaluate daptomycin prescribing practices and identify risk factors for muscle toxicity across three French university hospitals.

We conducted a retrospective multicenter study of adults (≥18 y) treated with daptomycin between June 2021 and May 2022. Data included demographics, treatment, monitoring, microbiology, and adverse events. Muscle toxicity was defined as an elevation of creatine kinase (CK) (>5 upper normal value) and/or rhabdomyolysis, identified by explicit documentation in medical records. Logistic regression identified associated factors.

We collected data from 1407 patients (65.1% male; mean age 62.4 ± 16.5) treated with daptomycin during the study period, for a mean duration of 7.87 ± 7.05 d. Most patients (93.9%) received high-dose daptomycin, ≥8 mg/kg/d. Combination therapy was frequent (72%), mostly with β-lactams (91.8%). CK monitoring was reported in 34.2% of patients, muscle toxicity was reported in 4.9%, including rhabdomyolysis in 2.7%. Statins were co-prescribed without discontinuation in 15.6% of cases. In multivariate analysis, concomitant use of high-risk comedications, including statins and fibrates (OR [95% CI] = 6.68 [3.28-13.97], P < 0.001) and obesity (OR 2.25 [1.07-4.72], P = 0.03) were independently associated with muscle toxicity.

Despite widespread use of high-dose daptomycin, safety monitoring was inconsistent. Systematic CK testing and careful review of myotoxic co-medications are essential to mitigate adverse events in clinical practice.