4CPS-053 Study on daptomycin use as a first step towards an antimicrobial stewardship programme

Background The use of daptomycin has increased in Spain since its approval and there is a great variability in the dosage and the criteria for its use in clinical practice. Purpose This study was aimed at reporting the real use of daptomycin in clinical practice, including its efficacy and tolerability as a first measure for the establishment of improvement actions. Material and methods Observational, retrospective study including all patients who started treatment with daptomycin during the period 1 January 2017 and 31 December 2017 in a Spanish tertiary hospital. The following variables were collected: age, sex, comorbidities, type of infection, dosage, microbiological results, analytical parameters such as creatinine or creatine phosphokinase (CPK), adverse events and clinical outcome. Results Overall, 176 patients (61.9% men), median age of 70 years (IQR: 57–79), began treatment with daptomycin during 2017. The median of the Charlson comorbidity index was 3 (IQR: 2–6). Daptomycin was mainly used to treat skin and soft-tissue infections (37.5%), fever without source (17.6%), osteoarticular infection (12.5%) and endocarditis (11.4%). A total of 63 patients (35.8%) presented a concomitant bacteremia. Daptomycin was prescribed empirically in 58.0% of patients. At the end of the follow-up, microbiological results were available in 89.2% of the total treated patients. Staphylococcus aureus was the most frequently isolated microorganism (58 microbiological isolates, only 10 resistant to methicillin). 43.8% of patients received doses≤6 mg/kg/day, whereas 23.9% received doses≥10 mg/kg/day. Infradosification was observed in at least 49 patients (27.8%), who received doses≤5 mg/kg/day. Daptomycin was administered for a median of 6 days (IQR: 3–13). CPK was only monitored in 47.7% of patients treated with daptomycin for ≥7 days. Clinical evolution was satisfactory in 77.7% of patients. Total mortality was 17.6% and mortality related to the infection was 7.4%. Five patients discontinued treatment due to adverse events (urticaria, cholestasis, increased CPK and rhabdomyolysis). No cases of resistance to the drug were reported. Conclusion Daptomycin is a well-tolerated and effective drug but is often prescribed empirically or in infections not caused by S. aureus methicillin resistant. The follow-up of patients treated with daptomycin should be considered a priority intervention within the Antimicrobial Stewardship Programmes. References and/or acknowledgements PMID: 29261926. No conflict of interest.