Daptomycin versus teicoplanin for bloodstream infection due to methicillin-resistant Staphylococcus aureus with a high teicoplanin minimal inhibitory concentration ≥1.5 mg/L: a propensity score-based analysis

• Published in: Infection and drug resistance 2018-01, Vol.11, p.2011-2020
• Main Authors: Tsai, Ching-Yen, Lee, Chen-Hsiang, Chen, I-Ling
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; antimicrobial susceptibility; Bacteremia; Bacteria; Clinical outcomes; Comparative analysis; Daptomycin; Drug dosages; Drug resistance; Drug therapy; Endocarditis; glycopeptide; Gram-positive bacteria; Hospitals; Illnesses; Infection; Infectious diseases; lipopeptide; Methicillin; Microbial drug resistance; Minimum inhibitory concentration; Multivariate analysis; Nosocomial infections; Original Research; Patients; pharmacodynamics; Regression analysis; Sepsis; Staphylococcal infections; Staphylococcus aureus; Staphylococcus aureus infections; Staphylococcus infections; Teicoplanin
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S184411

Recent reports have described decreased effectiveness of teicoplanin in the treatment of bacteremia due to methicillin-resistant (MRSA) with teicoplanin minimal inhibitory concentration (MIC) ≥1.5 mg/L. Consensus guidelines recommend considering use of alternative agents for MRSA infections involving a higher teicoplanin MIC, despite of limited data to support this recommendation. To compare the clinical outcome among patients with bacteremia due to MRSA with teicoplanin MIC ≥1.5 mg/L, we included patients who received high-dose daptomycin (≥8 mg/kg/day) and those who received standard-dose (6 mg/kg/day) or high-dose (6 mg/kg/12 hours) maintenance teicoplanin. The primary endpoint was a favorable outcome, defined as the resolution of clinical signs and symptoms and a negative culture report at the end of therapy. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Of 142 patients eligible for inclusion, 28 (19.7%) were treated with high-dose daptomycin, 27 (19.0%) with high-dose teicoplanin, and 87 (61.3%) with standard-dose teicoplanin. In multivariate regression analysis, Pittsburgh bacteremia score ≥4 (OR, 5.3; 95%CI, 1.9-14.5) was independently associated with an unfavorable outcome. After propensity-score matching with age and Pittsburgh bacteremia score ≥4, patients on high-dose daptomycin were more likely to have favorable outcomes than those on standard-dose teicoplanin (74.1% vs 42.6%; =0.02). However, there was no significant difference in terms of favorable outcomes ( =0.12) between patients receiving high-dose daptomycin and those receiving high-dose teicoplanin after the same propensity-score matching. Treatment with high-dose daptomycin resulted in significantly better outcomes than with standard-dose teicoplanin in the treatment of MRSA bacteremia with teicoplanin MIC ≥1.5 mg/L. However, the clinical outcome of the patients receiving high-dose teicoplanin was similar to that of the patients receiving high-dose daptomycin.