Methicillin-resistant Staphylococcal periprosthetic joint infections can be effectively controlled by systemic and local daptomycin

Abstract

BackgroundMethicillin-resistant Staphylococcus remains a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates were reported when vancomycin was used in 2-stage exchange arthroplasty. Therefore a better therapeutic drug is needed to treat PJI caused by methicillin-resistant organisms. The purpose of the study was to evaluate the safety and efficacy of daptomycin when administered in bone cement combined with systemic use for methicillin-resistant Staphylococci PJI.MethodsWe conducted a retrospective study from January 2010 to December 2012. Twenty-two patients (10 knees and 12 hips) with PJI caused by methicillin-resistant Staphylococcus species underwent 2-stage revision arthroplasty. In the first stage, 10 % daptomycin (weight daptomycin per weight bone cement) was incorporated into polymethylmethacrylate bone cement, and systemic daptomycin (6 mg/kg) was administered postoperatively for 14 days. In the second stage, 2.5 % w/w daptomycin was used in the bone cement. The minimum follow-up was 2 years or until recurrence of infection.ResultsThe infecting organisms included methicillin-resistant Staphylococcus aureus in 10 patients, methicillin-resistant Staphylococcus epidermidis in 8 patients and methicillin-resistant coagulase-negative Staphylococci in 4 patients. The mean follow-up duration was 33.7 months (range, 24–51 months). The treatment success rate was 100 %. Only one patient developed asymptomatic transient elevation of the creatine phosphokinase level. No patient experienced any adverse effects related to daptomycin such as myositis, rhabdomyolysis, peripheral neuropathy, derangement of liver function, or eosinophilic pneumonia.ConclusionsIn this series, no serious adverse events occurred. Our protocol, using daptomycin-impregnated cement combined with short duration of systemic daptomycin, appears to be an effective and safe treatment for methicillin-resistant Staphylococcus PJI.

Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?

“…Past reports of DAP treatment of PJI are shown in Table 3, and even some authors recommended the use of high-dose of DAP for the treatment of PJI with implant retention [2,[15][16][17][18][19][20][21].…”

Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?

“…Past reports of DAP treatment of PJI are shown in Table 3, and even some authors recommended the use of high-dose of DAP for the treatment of PJI with implant retention [2,[15][16][17][18][19][20][21]. Furthermore, the European Registry demonstrated high clinical success with DAP therapy, including both implant retention (56%) and removal (44%).…”

Current Strategies in Prevention of Postoperative Infections in Spine Surgery

“…However, there is evidence supporting the local use of daptomycin-loaded polymethylmethacrylate beads in patients with periprosthetic joint infections, and prosthetic vascular graft infections. 87,88 Hence, it can be speculated that daptomycin powder will emerge in the near future as an alternative intrawound antibiotic for patients who are allergic to vancomycin.…”