title: Study on daptomycin use and implementation of an antimicrobial stewardship program.
abstract: BACKGROUND
  Treatment of Gram-positive pathogens remains a major health issue due to the presence of methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus spp. Daptomycin offers an alternative after therapeutic failure using glycopeptides. Yet its use requires strict control given its financial impact and environmental risks. Since 2014, the use of daptomycin within our hospital has intensified, occasionally outside the scope of its approved indications.
  
  
  OBJECTIVE
  The aim of this study is to analyze the appropriateness of daptomycin prescriptions.
  
  
  METHODS
  This work was conducted in a 1500-bed University Hospital.
  
  
  METHODS
  A descriptive retrospective study was conducted from November 2013 to July 2014. All patients having received at least 2 days of treatment were included. Analysis of the appropriateness of daptomycin prescriptions was conducted by a multidisciplinary team comprised of infectious diseases specialists, pharmacists and a microbiologist. The appropriateness of daptomycin prescriptions was established based on Infectious Diseases Society of America recommendations published in 2011.
  
  
  METHODS
  The indicators chosen to determine appropriateness of prescription were: treatment indication, prescribed dose and other antibiotics associated with the daptomycin prescription.
  
  
  RESULTS
  19 patients (14 men/5 women) were included. Observed indications were: bone and joint infection (n = 6; 32 %), infectious endocarditis (n = 5; 26 %), bacteremia (n = 5; 26 %) and complicated skin and soft tissue infection (n = 3; 16 %). Identified pathogens were: MRSA (n = 14; 74 %), methicillin-resistant coagulase-negative Staphylococcus (n = 4; 21 %) and Streptococcus mitis (n = 1; 5 %). Daptomycin was prescribed as first-line treatment in 32 % of cases (n = 6). The mean dosage was 9 mg/kg/day (5-11 mg/kg/day) for a mean duration of 11 days (2; 55 days). Clinical success was observed in 42 % of cases (n = 8). Appropriateness for daptomycin use was only established for 15 % of prescriptions (n = 3).
  
  
  CONCLUSIONS
  Faced with a lack of recent recommendations on the subject, our multidisciplinary team issued a local consensus, defining the indications and dosage modalities for this reserve antibiotic. This multidisciplinary approach enables improved use of recent anti-MRSA drugs.
authors.affiliation: Service de pharmacie, centre hospitalier universitaire de Caen, avenue de la Côte de Nacre, 14033, Caen Cedex 9, France. camille.castel@outlook.com.
authors.forename: Camille
authors.initials: C
authors.lastname: Castel
authors.affiliation: Service des maladies infectieuses, centre hospitalier universitaire de Caen, 14033, Caen Cedex 9, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: de La Blanchardière
authors.affiliation: Service des maladies infectieuses, centre hospitalier universitaire de Caen, 14033, Caen Cedex 9, France.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Michon
authors.affiliation: Service de microbiologie, centre hospitalier universitaire de Caen, 14033, Caen Cedex 9, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cattoir
authors.affiliation: Service de pharmacie, centre hospitalier universitaire de Caen, avenue de la Côte de Nacre, 14033, Caen Cedex 9, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saint-Lorant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017576:Daptomycin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D033183:Interdisciplinary Communication; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: Antimicrobial stewardship; Bone and joint infection; Daptomycin; Endocarditis; France; Prescribing audit