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Daptomycin in the treatment of osteomyelitis caused by MRSA. A comparative observational study

Abstract number: P1552

Ascione T., Iannece M.D., Rosario P., Conte M., Quaranta S., Pempinello R.

New antibiotics have recently been shown to be effective in cases of serious infections sustained by Meticillin-resistant Staphylococcus aureus (MRSA) strains. Objectives: to compare the efficacy of Teicoplanin in respect to Linezolid and Daptomycin in patients with chronic osteomyelitis sustained by MRSA.

Materials and Methods: In an observational study we included all cases of osteomyelitis sustained by MRSA treated with Teicoplanin, Linezolid or Daptomycin during the last 3 years in our division. Epidemiological, laboratory and microbiological findings were considered. Patients were evaluated for clinical efficacy, safety and tolerability. Cure was defined by the clinical and radiologic evidences, coupled with a negative Magnetic Resonance Imaging study or by the absence of captation by scintigraphic examination with leukocytes labelled in vitro with 111In, as was assessed 3 months after the end of treatment.

Results: Fifty-three patients with post-traumatic chronic osteomyelits (median age 58 [range 19–70], 66% males) were included. Fracture fixators were present in 10 (19%) cases. Median (range) time from diagnosis of chronic osteomyelitis to our observation was 9 months (range 3–12). Ineffective antimicrobial treatment before our observation was reported in 32 patients. We treated 29 patients with Teicoplanin, 13 with Linezolid and 11 with Daptomycin. Median (range) length of antibiotic treatment was 16 (12–24) weeks for cases treated with Teicoplanin, 12 (8–12) weeks for cases treated with Linezolid, and 11 (6–12) weeks for cases treated with Daptomycin. Cure rates (intention to treat evaluation) were 83%, 77% and 91%, respectively, for cases receiving Teicoplanin, Linezolid and Daptomycin. Antibiotic treatment was discontinued in 3 patients receiving Linezolid because of side effects (2 cases had optic neuritis, 1 had moderate anemia). Three patients who failed after Teicoplanin treatment had MIC to Teicoplanin between 1 and 2 microg/ml.

Conclusion: Teicoplanin is largely employed in the daily practice for patients with osteomyelitis. However, it needs to be administered for a longer period and it is not always effective because of the emergence of glycopeptides tolerant MRSA. Many concerns arise in suggesting the long term administration of Linezolid because of side effects on the nervous and haemopoietic systems. Daptomycin whose administration was safe and effective represents an effective choice for all cases with osteomyelitis sustained by MRSA.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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