Streamlining Daptomycin Therapy in an Academic Medical Center

Abstract

Objectives: Emerging gram-positive resistance and treatment failure associated with vancomycin have led to increased utilization of daptomycin (DAP). DAP requires an antimicrobial stewardship pharmacist (ASP) review and infectious diseases approval and consultation at our institution. The primary objective of this study is to assess the appropriate utilization of DAP and the impact of ASP on daptomycin de-escalation. Methods: This retrospective chart review included all adult inpatients who receive ≥ 24 hours of DAP between October 1st and December 31st 2015. Exclusion criteria included concomitant use of DAP and intravenous vancomycin for >24 hours. Clinical, microbiological, and pharmacy data were collected and analyzed using descriptive statistics. Results: Thirty-six patients were included and 19.4% were hemodialysis patients. Most frequent type and sources of infection were bacteremia (66.7%), and endovascular (22.2%) and osteoarticular (16.3%) sources. Methicillin-resistant Staphylococcus aureus (38%) and vancomycin-resistant Enterococcus spp. (27%) were the most common pathogens isolated. DAP was utilized as empirically in 55.6% of patients, and 41.7% of patients were switched from daptomycin to alternative agents, primarily for de-escalation. 18 of 21 patients remaining on daptomycin were treated appropriately and indicated most commonly for vancomycin allergy/intolerance (28.6%). Median weight-based dosing for Enterococcal and Staphylococcal bacteremia (range) were 8 (5.5 to 8.9) and 7.7 (5.8-10.9), respectively. Conclusions: Overall, DAP therapy was appropriately indicated in more than 90% of patients initiated on therapy and 41.7% of patients were de-escalated. There is a beneficial impact of ASP on streamlining patients on DAP to appropriate therapy. Further studies are needed to evaluate clinical outcomes and cost-effectiveness.