title: Safety and effectiveness of daptomycin across a hospitalized obese population: results of a multicenter investigation in the southeastern United States.
abstract: OBJECTIVE
  Data are limited for antimicrobial outcomes in obese patients. This study investigated the safety and clinical outcomes of daptomycin therapy in a hospitalized obese population in the southeastern United States.
  
  
  METHODS
  Multicenter retrospective cohort study.
  
  
  METHODS
  Thirteen hospitals in the southeastern United States.
  
  
  METHODS
  A total of 126 hospitalized adult obese patients (body mass index [BMI] more than 30 kg/m(2) ) admitted from January 2005 through May 2010 who received daptomycin dosed on actual body weight for any indication for a minimum of 7 days.
  
  
  RESULTS
  Primary safety outcomes included incidence of creatine phosphokinase (CPK) elevations more than 1000 units/L, more than 500 units/L, myalgias, and discontinuation of therapy due to adverse drug events (ADEs). Patients were stratified by BMI class (I, II, or III) for analyses. The average weight was 121 kg, and 39% of patients were considered morbidly obese. Factors associated with an increased risk of primary safety outcomes were assessed through regression analysis. Clinical effectiveness was evaluated as a secondary outcome. CPK elevations more than 1000 units/L occurred in 8.4% of evaluable patients and specifically in 1 (3.6%), 3 (10.3%), and 4 (10.5%) patients in BMI class I, II, and III, respectively (p=0.554). CPK elevations more than 500 units/L occurred in 13.7% of patients with no statistically significant difference noted across BMI classes. Discontinuation due to ADEs occurred in 8 patients (6.3%). One patient developed rhabdomyolysis on day 9 of therapy. Clinical effectiveness was documented in 71% of patients and was consistent across BMI classes.
  
  
  CONCLUSIONS
  Although elevations in CPK increased in high-risk obese patients on daptomycin, discontinuation rates due to ADEs remained low. Further evaluation in a prospective trial is warranted.
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bland
authors.forename: Zaina P
authors.initials: ZP
authors.lastname: Qureshi
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Faulkner-Fennell
authors.forename: Margrit A
authors.initials: MA
authors.lastname: Sheldon
authors.forename: Celeste R
authors.initials: CR
authors.lastname: Caulder
authors.forename: Charles
authors.initials: C
authors.lastname: Hartis
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D001835:Body Weight; D015331:Cohort Studies; D003402:Creatine Kinase / Q000378:metabolism; D017576:Daptomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications; D012044:Regression Analysis; D012189:Retrospective Studies; D015144:Southeastern United States; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003402:Creatine Kinase; D017576:Daptomycin
keywords: HMG Co-A reductase; Staphylococcus aureus; creatine phosphokinase; daptomycin; morbid obesity; obesity