title: Methicillin-resistant Staphylococcal periprosthetic joint infections can be effectively controlled by systemic and local daptomycin.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus remains a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates were reported when vancomycin was used in 2-stage exchange arthroplasty. Therefore a better therapeutic drug is needed to treat PJI caused by methicillin-resistant organisms. The purpose of the study was to evaluate the safety and efficacy of daptomycin when administered in bone cement combined with systemic use for methicillin-resistant Staphylococci PJI.
  
  
  METHODS
  We conducted a retrospective study from January 2010 to December 2012. Twenty-two patients (10 knees and 12 hips) with PJI caused by methicillin-resistant Staphylococcus species underwent 2-stage revision arthroplasty. In the first stage, 10% daptomycin (weight daptomycin per weight bone cement) was incorporated into polymethylmethacrylate bone cement, and systemic daptomycin (6 mg/kg) was administered postoperatively for 14 days. In the second stage, 2.5% w/w daptomycin was used in the bone cement. The minimum follow-up was 2 years or until recurrence of infection.
  
  
  RESULTS
  The infecting organisms included methicillin-resistant Staphylococcus aureus in 10 patients, methicillin-resistant Staphylococcus epidermidis in 8 patients and methicillin-resistant coagulase-negative Staphylococci in 4 patients. The mean follow-up duration was 33.7 months (range, 24-51 months). The treatment success rate was 100%. Only one patient developed asymptomatic transient elevation of the creatine phosphokinase level. No patient experienced any adverse effects related to daptomycin such as myositis, rhabdomyolysis, peripheral neuropathy, derangement of liver function, or eosinophilic pneumonia.
  
  
  CONCLUSIONS
  In this series, no serious adverse events occurred. Our protocol, using daptomycin-impregnated cement combined with short duration of systemic daptomycin, appears to be an effective and safe treatment for methicillin-resistant Staphylococcus PJI.
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. fongchikuo@cgmh.org.tw.|Chang Gung University College of Medicine, Kaohsiung, Taiwan. fongchikuo@cgmh.org.tw.
authors.forename: Feng-Chih
authors.initials: FC
authors.lastname: Kuo
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. yswings@cloud.cgmh.org.tw.|Chang Gung University College of Medicine, Kaohsiung, Taiwan. yswings@cloud.cgmh.org.tw.
authors.forename: Shih-Hsiang
authors.initials: SH
authors.lastname: Yen
authors.affiliation: Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan. mr3497@adm.cgmh.org.tw.
authors.forename: Kuo-Ti
authors.initials: KT
authors.lastname: Peng
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. wang0155@cgmh.org.tw.|Chang Gung University College of Medicine, Kaohsiung, Taiwan. wang0155@cgmh.org.tw.
authors.forename: Jun-Wen
authors.initials: JW
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. mellee@cgmh.org.tw.|Chang Gung University College of Medicine, Kaohsiung, Taiwan. mellee@cgmh.org.tw.
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology; D001843:Bone Cements; D017576:Daptomycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D014640:Vancomycin; D017576:Daptomycin
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