Daptomycin use in patients with osteomyelitis: a preliminary report from the EU-CORE(SM) database

Abstract

Background: Osteomyelitis is a complex and heterogeneous group of infections that require surgical and antimicrobial interventions. Because treatment failure or intolerance is common, new treatment options are needed. Daptomycin has broad Gram-positive activity, penetrates bone effectively and has bactericidal activity within biofilms. This is the first report on clinical outcomes in patients with osteomyelitis from the multicentre, retrospective, non-interventional European Cubicin(®) Outcomes Registry and Experience (EU-CORE(SM)), a large database on real-world daptomycin use.

Patients and methods: In total, 220 patients were treated for osteomyelitis; the population was predominantly elderly, with predisposing baseline conditions such as diabetes and chronic renal/cardiac diseases.

Results: Most patients (76%) received prior antibiotic treatment, and first-line treatment failure was the most frequent reason to start daptomycin. Common sites of infection were the knee (22%) or hip (21%), and the most frequently isolated pathogens were Staphylococcus aureus (33%) and coagulase-negative staphylococci (32%). Overall, 52% of patients had surgery, 55% received concomitant antibiotics and 29% received a proportion of daptomycin therapy as outpatients. Clinical success was achieved in 75% of patients. Among patients with prosthetic device-related osteomyelitis, there was a trend towards higher success rates if the device was removed. Daptomycin was generally well tolerated.

Conclusions: This analysis suggests that daptomycin is an effective and well-tolerated treatment option for osteomyelitis and highlights the importance of optimal surgical intervention and appropriate microbiological diagnosis for clinical outcomes.

Keywords: Gram-positive infections; bone infections; lipopeptides; non-interventional study; prosthetic device infections.

Figure 1.

(a) Treatment outcomes by primary infection type (efficacy population). Clinical success: cure or improved outcome. (b) Treatment outcomes by primary infection pathogen (efficacy population). Clinical success: cure or improved outcome. ^aEnterococcus species includes Enterococcus faecalis and Enterococcus faecium. CoNS, coagulase-negative staphylococcal species.

Figure 2.

Baseline and peak serum CPK concentrations (safety population with measurements available). Values were missing or not measured for 95 patients at baseline and for 69 patients on treatment. ULN, upper limit of normal.