title: Successful use of daptomycin in Panton-Valentine leucocidin positive Staphylococcus aureus paediatric osteomyelitis.
abstract: BACKGROUND
  Efficacy of daptomycin has been recorded in adult Gram-positive bone and joint infections OAI (1) and daptomycin has been used as secondary or tertiary agent when primary agents have failed (1, 2) in the treatment of osteoarticular infections caused by Staphylococcus aureus.
  
  
  METHODS
  We report a 16-year-old schoolboy with Panton-Valentine Leucocidin (PVL) positive methicillin susceptible S. aureus osteomyelitis, who was refractory to 9days of recognised antimicrobial chemotherapy with progressive multifocal haematogenous spread. Subsequent addition of daptomycin promptly cleared the bacteraemia and arrested the disease process within 9days.
  
  
  CONCLUSIONS
  Although cases have been reported of daptomycin usage in children with invasive staphylococcus bacteraemia, endocarditis and OAI (2), we believe this to be the first case report describing the use of daptomycin in paediatric osteomyelitis caused by PVL positive S. aureus.
  
  
  CONCLUSIONS
  Repercussions of osteomyelitis, in particular those caused by PVL S. aureus, and evolving resistance patterns internationally, highlight the need for further evaluation of daptomycin in the paediatric arena. The response seen with the addition of Daptomycin in this case suggests possible reduction in hospital stay and number of surgical procedures when compared to other published series using conventional antibiotic regimens.
authors.affiliation: Department of Trauma and Orthopaedics, Royal Berkshire Hospital, London Road, Reading RG1 5AQ, UK.
authors.forename: Gurhan
authors.initials: G
authors.lastname: Erturan
authors.forename: Harriet
authors.initials: H
authors.lastname: Holme
authors.forename: Ralph
authors.initials: R
authors.lastname: Smith
authors.forename: Richard
authors.initials: R
authors.lastname: Dodds
authors.forename: Shabnam
authors.initials: S
authors.lastname: Iyer