Successful salvage therapy with Daptomycin for osteomyelitis caused by methicillin-resistant Staphylococcus aureus in a renal transplant recipient with Fabry-Anderson disease

Abstract

Daptomycin is licensed in adults for the management of Staphylococcus aureus methicillin-resistant infections, including bone and skin complicated infections. We describe for the first time its use in a renal transplant recipient for Fabry-Anderson Disease with right heel osteomyelitis. The patient was unresponsive to first-line Teicoplanin and second-line Tigecycline, whereas he was successfully treated with third-line Daptomycin monotherapy at 4 mg/Kg/qd for 4 weeks. Local debridement was performed in advance of each line of treatment.

Tigecycline in the management of osteomyelitis: a case series from the bone and joint infection (BAJIO) database

“…Similar to our findings, low rates of discontinuation due to adverse effects were documented after treatment for ≥6 weeks, although dosing regimens were not elucidated in this series as in our investigation. In contrast to the current study and these previous reports, another report has documented failure of tigecycline in the acute treatment of MRSA calcaneal osteomyelitis (Polilli et al, 2012); however, this patient had also failed a previous regimen and was plagued by multiple comorbidities, making it difficult to generalize the findings. The preponderance of gastrointestinal side effects noted in our analysis is similar to that seen in prior literature (Passarell et al, 2009;Tasina et al, 2011), although we did not find a dose-response relationship.…”

“…Finally, a case series of six patients has elucidated favorable outcomes in S. epidermidis osteomyelitis (Asseray et al, 2012). In contrast, one report has noted failure of tigecycline in an MRSA bone infection (Polilli et al, 2012). However, to our knowledge, this antibiotic has not undergone additional scrutiny in the literature regarding osteomyelitis.…”

Multidrug-resistant bacteria in solid organ transplant recipients

“…In SOT patients, the most frequent bacterial targets for the use of daptomycin are S. aureus and VRE. The information available regarding the safety and efficacy of daptomycin in SOT patients is limited to case reports . In the major clinical trials with daptomycin, the drug was well tolerated and its profile of adverse effects was similar to that of the comparator drugs .…”

Daptomycin is safe and effective for the treatment of gram‐positive cocci infections in solid organ transplantation

“…The published information on daptomycin administration in solid organ transplantation is limited to case studies (15,16) or retrospective cohorts in which a portion of evaluated patients were SOT recipients (17). In these studies, the drug was found to be safe and well tolerated for an extended duration of treatment.…”

“…Six patients (13.9%) ended treatment on an outpatient regimen. Treatment was administered for a median duration of 12 days (IQR [8][9][10][11][12][13][14][15][16][17][18][19][20]. Co-infection with gram-negative rods was diagnosed in 15 (34.9%) patients, mainly corresponding to Pseudomonas aeruginosa (6 patients), and Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, with 2 patients each.…”