Association of Higher Daptomycin Dose (7 mg/kg or Greater) with Improved Survival in Patients with Methicillin‐Resistant Staphylococcus aureus Bacteremia

Abstract

To our knowledge, this is the first comparative effectiveness study of daptomycin doses in patients with MRSA bacteremia. Survival benefits were observed with doses higher than the daptomycin label dose (7 mg/kg or greater) for the treatment of MRSA bacteremia. These data suggest that higher doses than the daptomycin label dose may be preferred over the label dose for improving clinical outcomes in patients with MRSA bacteremia.

Treatment strategies for persistent methicillin‐resistantStaphylococcus aureusbacteraemia

“…Both the IDSA and the European Society of Cardiology recommend higher doses of daptomycin for endovascular infections as well as for persistent MRSA bacteraemia secondary to the drug's concentration‐dependent killing . The safety and efficacy of high‐dose daptomycin (up to 12 mg/kg) are well described . This section will focus on combination therapy.…”

“…4,13 The safety and efficacy of highdose daptomycin (up to 12 mg/kg) are well described. [14][15][16][17][18] This section will focus on combination therapy. For a summary of available evidence, see Table 1.…”

Successful Clearance of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia with Daptomycin, Linezolid, and Meropenem Salvage Therapy

“…In the case illustrated above, blood cultures remained positive for MRSA despite 6 days of daptomycin at the standard dose of 6 mg/kg. Based on data published in 2017 by Timbrook et al escalating daptomycin doses beyond 6 mg/kg provided more benefit in patients with a higher predicted probability of 30-day mortality (51% or greater) [4]. This continued deterioration of the patient's clinical status prompted the addition of antistaphylococcal therapy for urgent clearance of blood cultures.…”

“…Persistent MRSA bacteremia is defined by the IDSA guidelines as positive blood cultures past seven days of adequate therapy at effective doses of appropriate antibiotics [1]. Guidance in situations of persistent MRSA bacteremia is currently directed solely through case-series and case reports involving daptomycin and vancomycin in combination with salvage antibiotics for clearance of blood cultures [4–10]. A patient is presented here with persistent MRSA bacteremia and clearance of blood cultures following escalation to salvage therapy with daptomycin, linezolid, and meropenem.…”

Management of Pediatric Acute Hematogenous Osteomyelitis, Part II: A Focus on Methicillin‐Resistant Staphylococcus aureus, Current and Emerging Therapies

“…This was further demonstrated by recent outcome data in adults with S. aureus bacteremia. Patients who received higher daptomycin doses had a lower 30‐day mortality (8.6% vs 18.6%, hazard ratio 0.31 #bib95% CI 0.10–0.94) …”