title: Daptomycin for Gram-positive Infections in Patients with Neutropenia: Clinical Experience from a European Outcomes Registry.
abstract: BACKGROUND
  The aim of this analysis was to describe in real-world settings the clinical outcomes and safety associated with daptomycin treatment in patients with neutropenia and Gram-positive infections.
  
  
  METHODS
  Patients with an absolute neutrophil count (ANC) ≤1000 cells/mm(3) who received at least one dose of daptomycin between 2006 and 2012 were selected from a non-interventional, multicenter, retrospective registry (European Cubicin(®) Outcome Registry and Experience; EU-CORE(SM)).
  
  
  RESULTS
  Of the 6075 patients enrolled in EU-CORE, 446 (7.3%) had an ANC ≤ 1000 cells/mm(3) at baseline or during daptomycin therapy; they were all included in efficacy and safety populations. Half of the patients had severe neutropenia (ANC ≤ 100 cells/mm(3)). Most patients had hematologic malignancy (60.5%), an immunosuppressed state (39.7%) or had undergone a transplant (27.8%). The most common primary infections were bacteremia (42.2%) and complicated skin and soft tissue infection (13.9%). Cultures were positive for 68.6% (254/370) of patients with available culture results; coagulase-negative staphylococci (43.7%; 111/254) and Staphylococcus aureus (18.9%; 48/254) were the most commonly isolated primary pathogens. Median duration of daptomycin therapy was 10.0 (range 1-98) days. Most patients (82.8%) received antibiotics concomitantly with daptomycin; the most common were carbapenems (51.2%), penicillins (42.1%), and aminoglycosides (19.9%). The overall clinical success rate (cured or improved) associated with daptomycin was 77.1%. Adverse events possibly related to daptomycin treatment were reported in seven (1.6%) patients and led to drug discontinuation in 27 (6.1%) patients.
  
  
  CONCLUSIONS
  The study results suggest that daptomycin is an effective therapeutic option for the treatment of a broad range of Gram-positive infections in patients with neutropenia, and has a good safety profile.
  
  
  BACKGROUND
  This study was funded by Novartis Pharma AG.
authors.affiliation: Hanusch Krankenhaus der Wiener Gebietskrankenkasse-Medizinische Abteilung, Heinrich Collin-Strasse, Vienna, Austria.
authors.forename: Felix
authors.initials: F
authors.lastname: Keil
authors.affiliation: National University of Athens-Laiko General Hospital, Athens, Greece.
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.affiliation: Evangelismos General Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Skoutelis
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Jose Ignacio Barranco
authors.initials: JI
authors.lastname: Dominguez
authors.affiliation: Novartis Healthcare Pvt. Ltd, Hyderabad, India.
authors.forename: Rashidkhan
authors.initials: R
authors.lastname: Pathan
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. kamal.hamed@novartis.com.
authors.forename: Kamal
authors.identifier: http://orcid.org/0000-0003-1896-9736
authors.initials: K
authors.lastname: Hamed
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D017576:Daptomycin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: Daptomycin; EU-CORE; Gram-positive infections; Neutropenia; Staphylococci