Daptomycin versus vancomycin for complicated skin and skin structure infections: clinical and economic outcomes.
OBJECTIVE
To assess the effect of daptomycin compared with vancomycin on the clinical and economic outcomes in patients with complicated skin and skin structure infections.


METHODS
Prospective, open-label study.


METHODS
Level 1 trauma center in Detroit, Michigan.


METHODS
Fifty-three adult patients with complicated skin and skin structure infections at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection who were treated with daptomycin and a matched cohort of 212 patients treated with vancomycin.


METHODS
Patients in the prospective arm received intravenous daptomycin 4 mg/kg every 24 hours for at least 3 days but not more than 14 days. Historical controls received at least 3 days of vancomycin dosed to achieve trough concentrations of 5-20 microg/ml.


RESULTS
Outcomes evaluated included blinded assessments of clinical resolution, duration of therapy, and costs. The most common diagnoses were cellulitis (31%), abscess (22%), and both cellulitis with abscess (37%). Microbiology differed significantly between groups, with S. aureus found in 27 patients (51%) in the daptomycin group and 167 patients (79%) in the vancomycin group and MRSA in 22 (42%) and 159 (75%), respectively (p<0.001). The proportions of patients with clinical improvement or resolution of their infections on days 3 and 5 were 90% versus 70% and 98% versus 81% in the daptomycin versus vancomycin groups, respectively (p<0.01 for both comparisons), and 100% at the end of therapy in both groups. Among patients with complete resolution of their infections (41 patients [77%] with daptomycin vs 89 patients [42%] with vancomycin, p<0.05), median duration of intravenous therapy was 4 and 7 days, respectively, (p<0.001), and hospital costs were $5027 and $7552 (p<0.001).


CONCLUSIONS
Patients receiving daptomycin achieved more rapid resolution of symptoms and clinical cure and had a decreased duration of inpatient therapy compared with those receiving vancomycin. This study suggests that daptomycin is a cost-effective alternative to vancomycin for complicated skin and skin structure infections.
Davis
Susan L
SL
Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
McKinnon
Peggy S
PS
Hall
Levi M
LM
Delgado
George
G
Rose
Warren
W
Wilson
Robert F
RF
Rybak
Michael J
MJ
D000038:Abscess / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D003362:Cost-Benefit Analysis; D017576:Daptomycin / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D017576:Daptomycin