Table 4

Clinical summary of cases of S. aureus bacteremia and mild or moderate renal insufficiency that were classified as daptomycin treatment failuresa

Patient no.Age range (yr), sexUnderlying condition(s)MRSA or MSSA, BSI sourceAntibiotics received prior to DAPDAP therapyComments
1>80, MNeutropenia (ANC, <100), HTN, CV disease, COPD, anemia, acute kidney injury, solid organ malignancyMRSA, central catheterVAN6 mg/kg q24h for 4 daysSwitched to alternative therapy; expired after DAP therapy; infected central catheter (Port-A-Cath) not removed
2>80, FCHF, CV diseaseMRSA, biomedical device infectionVAN (treatment failure)7 mg/kg q48h for 3 days (CLCR of <30 ml/min)Medical care was withdrawn after 3 days of DAP; infected biomedical device not removed
3>80, MCV diseaseMRSA, biomedical device infectionVAN (treatment failure)8 mg/kg q48h for 7 days (CLCR of <30 ml/min) + RIFNo documentation of device removal; recurrence 10 days after DAP was discontinued; DAP MIC, >3 μg/ml; patient received LZD + ampicillin-sulbactam + RIF
466–80, MHTNMSSA, unknown sourceVAN4 mg/kg q48h for 2 days (CLCR of <30 ml/min)DAP dose less than FDA-recommended dose
551–65, MDM, CV disease, CHF, GI bleedMRSA, unknown sourceVAN3.7 mg/kg, then 5.7 mg/kg q48h for 32 daysDAP dose less than FDA-recommended dose; concomitant vancomycin-resistant Enterococcus faecium bacteremia; patient expired after DAP was discontinued
651–65, FHTNMSSA, unknown sourceFailed antibiotics other than VAN6 mg/kg q24h for 7 days + RIFClinical response was unknown/lost to follow-up, deemed a failure
7>80, FDM, HTNMRSA, unknown sourceReceived prior antibiotic for BSI, other than VAN5 mg/kg q24h for 9 daysDose less than FDA-recommended dose; patient expired after DAP was discontinued
866–80, MDM, HTN, PVD, PE/DVT, acute kidney injuryMRSA, left-sided IEVAN (treatment failure)6 mg/kg q48h for 58 days (CLCR of <30 ml/min) + RIFNo surgical intervention; aortic valve involved
966–80, MBPHMRSA, left-sided IEVAN (treatment failure)4 mg/kg for 1 dayDose less than that recommended by most experts; surgical intervention not documented
1031–50, FAcute kidney injury, hematologic malignancyMRSA, central catheterVAN (treatment failure)6 mg/kg q48h for 10 days (CLCR of <30 ml/min)Prior VAN failure; no documentation of catheter removal during DAP therapy
1151–65, FSepsis/septicemia, acute coronary syndrome, CV disease, CHF, HTNMSSA, unknown sourceNone4 mg/kg q48h (CLCR of <30 ml/min)DAP dose less than FDA-recommended dose; therapy was switched; patient expired after DAP was discontinued
1266–80, MCardiac arrhythmias, HTN, COPDMRSA, right-sided IEVAN6 mg/kg q48h for 7 days + GEN + RIFPatient expired during DAP therapy; no surgery documented
1351–65, MHTN, liver diseaseMSSA, unknown sourceVAN6 mg/kg q24h for 2 days + GENAfter 2 days of DAP, therapy was switched to an alternative regimen
1466–80, FDM, HTN, PVDMRSA, OMVAN (treatment failure)6 mg/kg q24h for 9 daysSurgical intervention performed; DAP was discontinued because the case was deemed a DAP treatment failure
15>80, MCV disease, anemia/hematologic disease, solid organ malignancyMRSA, unknown sourceVAN (treatment failure)6 mg/kg q24h for 5 daysPatient expired after 5 days of DAP therapy
  • a ANC, absolute neutrophil count; BPH, benign prostatic hypertrophy; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; DAP, daptomycin; DM, diabetes mellitus; F, female; GEN, gentamicin; GI, gastrointestinal; HTN, hypertension; IE, infective endocarditis; LZD, linezolid; M, male; OM, osteomyelitis; PE/DVT, pulmonary embolism and deep vein thrombosis; PVD, peripheral vascular disease; RIF, rifampin; VAN, vancomycin.