%0 Journal Article %1 Murray2013 %A Murray, Kyle P. %A Zhao, Jing J. %A Davis, Susan L. %A Kullar, Ravina %A Kaye, Keith S. %A Lephart, Paul %A Rybak, Michael J. %D 2013 %J Clin Infect Dis %K mrsa vancomycin drugresistance bacteremia staph %N 11 %P 1562--1569 %R 10.1093/cid/cit112 %T Early Use of Daptomycin Versus Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia With Vancomycin Minimum Inhibitory Concentration >1 mg/L: A Matched Cohort Study. %U http://dx.doi.org/10.1093/cid/cit112 %V 56 %X Background. Recent reports have described decreased effectiveness with vancomycin treatment for methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) when the vancomycin minimum inhibitory concentration (MIC) is >1 µg/mL. Methods. This matched, retrospective cohort study compared the clinical effectiveness of daptomycin with that of vancomycin for the treatment of MRSAB with vancomycin MICs >1 µg/mL. The primary outcome was clinical failure, defined as a composite of 30-day mortality or bacteremia persisting for ≥7 days. Results. One hundred seventy patients were matched 1:1 with respect to the antimicrobial administered. In the daptomycin group, all patients received <72 hours of vancomycin (median, 1.7 days interquartile range, 1.1-2.3 days) prior to switching to daptomycin. The rate of clinical failure at 30 days was significantly lower in the daptomycin arm compared to the vancomycin arm (20.0\% vs 48.2\%; P < 0.001). Both 30-day mortality and persistent bacteremia were significantly lower in the daptomycin group compared to the vancomycin group (3.5\% vs 12.9\% P = .047 and 18.8\% vs 42.4\% P = .001, respectively). Logistic regression confirmed the association between vancomycin treatment and increased risk of clinical failure (adjusted odds ratio, 4.5; 95\% confidence interval, 2.1-9.8). Conclusions. This is the first matched study comparing early daptomycin versus vancomycin for the treatment of MRSAB when the vancomycin MIC is >1 µg/mL. Treatment with daptomycin resulted in significantly improved outcomes, including decreased 30-day mortality and persistent bacteremia. These results support the practice of switching early from vancomycin to daptomycin for the treatment of MRSAB when the vancomycin MIC is >1 µg/mL.

@article{Murray2013, abstract = {Background. Recent reports have described decreased effectiveness with vancomycin treatment for methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) when the vancomycin minimum inhibitory concentration (MIC) is >1 µg/mL. Methods. This matched, retrospective cohort study compared the clinical effectiveness of daptomycin with that of vancomycin for the treatment of MRSAB with vancomycin MICs >1 µg/mL. The primary outcome was clinical failure, defined as a composite of 30-day mortality or bacteremia persisting for ≥7 days. Results. One hundred seventy patients were matched 1:1 with respect to the antimicrobial administered. In the daptomycin group, all patients received <72 hours of vancomycin (median, 1.7 days [interquartile range, 1.1-2.3 days]) prior to switching to daptomycin. The rate of clinical failure at 30 days was significantly lower in the daptomycin arm compared to the vancomycin arm (20.0\% vs 48.2\%; P < 0.001). Both 30-day mortality and persistent bacteremia were significantly lower in the daptomycin group compared to the vancomycin group (3.5\% vs 12.9\% [P = .047] and 18.8\% vs 42.4\% [P = .001], respectively). Logistic regression confirmed the association between vancomycin treatment and increased risk of clinical failure (adjusted odds ratio, 4.5; 95\% confidence interval, 2.1-9.8). Conclusions. This is the first matched study comparing early daptomycin versus vancomycin for the treatment of MRSAB when the vancomycin MIC is >1 µg/mL. Treatment with daptomycin resulted in significantly improved outcomes, including decreased 30-day mortality and persistent bacteremia. These results support the practice of switching early from vancomycin to daptomycin for the treatment of MRSAB when the vancomycin MIC is >1 µg/mL.}, added-at = {2013-06-01T04:14:12.000+0200}, author = {Murray, Kyle P. and Zhao, Jing J. and Davis, Susan L. and Kullar, Ravina and Kaye, Keith S. and Lephart, Paul and Rybak, Michael J.}, biburl = {https://www.bibsonomy.org/bibtex/2b82a869ec24130882e01e54d871608bd/aorchid}, description = {see also Moore2012 same center. All Cubist funding to investigators like other article. Retrospective, single center. Median dapto dose was 8.4mg/kg. 94% isolates had MIC vanco 2. High rate of clinical failure in vanco group of 48% versus 20% in dapto. Notes difficulty getting AUC/MIC target of >421 even in patients with troughs >15. See also Weston2013 commentary (same people that did last time). Excluded catheter related infections, Excluded renal failure patients; a group for which dapto has been shown as less effective.}, doi = {10.1093/cid/cit112}, file = {:ID_General/ClinInfectDis.56.1562.pdf:PDF}, groups = {public}, institution = {Department of Pharmacy, Detroit Medical Center.}, interhash = {dbd5e770666e5d20f696390dc5e9e2ed}, intrahash = {b82a869ec24130882e01e54d871608bd}, journal = {Clin Infect Dis}, keywords = {mrsa vancomycin drugresistance bacteremia staph}, language = {eng}, medline-pst = {ppublish}, month = Jun, number = 11, pages = {1562--1569}, pii = {cit112}, pmid = {23449272}, timestamp = {2013-06-05T22:41:31.000+0200}, title = {Early Use of Daptomycin Versus Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia With Vancomycin Minimum Inhibitory Concentration >1 mg/L: A Matched Cohort Study.}, url = {http://dx.doi.org/10.1093/cid/cit112}, username = {aorchid}, volume = 56, year = 2013 }