The Efficacy of Daptomycin versus Vancomycin for MRSA Bloodstream Infection in Patients with Impaired Renal Function.
There is an increasing use of daptomycin for Methicillin-resistant Staphylococcus Aureus
(MRSA) bloodstream infections. However, there has been concern regarding its efficacy in
patients with impaired renal function, reflected in a recent package insert change by
the FDA. However, this decision was based on a small, post-hoc subgroup analysis and it
is unclear whether ... read morethis is a true association. Methods: We performed a single center,
retrospective cohort study of patients with MRSA bloodstream infection who received at
least 3 consecutive days of either vancomycin or daptomycin. Vancomycin treated patients
were matched 2:1 with daptomycin patients using a propensity score built to estimate
their propensity to receive daptomycin, n=150 total. After matching, additional
conditional logistic regression was used to evaluate for outcome of treatment failure (a
composite of in hospital mortality, persistent bacteremia, or recurrence) in vancomycin
vs. daptomycin treated subjects across various renal functions. Results: In our
multivariable model, neither the usage of daptomycin (OR 0.45, 95% CI 0.11-1.79) nor a
GFR of <50 ml/min/1.73m2 (OR 1.06, 95%CI 0.4-2.86) were significantly associated with
treatment failure (Table 3). Additionally, there was no significant interaction between
them (p=0.6) indicating that the effect of daptomycin, compared to vancomycin, did not
differ significantly in patients with either a GFR greater than or less than 50
ml/min/1.73m2. Similar non-significant results were seen for the individual outcomes of
mortality, persistent bacteremia, and recurrence. In addition, there was no significant
variation of the treatment effect of the use of daptomycin across the stages of chronic
kidney disease. Conclusions: In our study we did not find a significant interaction of
renal function with antibiotic choice. However, our sample size was small and smaller
effects may be significant in a larger prospective
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Snydman.
Committee: Yoav Golan, Christina Holcroft, and John Griffith.
Keyword: Health sciences.read less
- Component ID:
- To Cite:
- TARC Citation Guide EndNote