Efficacy of Daptomycin-Containing Regimen for Treatment of Staphylococcal or Enterococcal Vertebral Osteomyelitis: A Prospective Clinical Experience

• Main Authors: Alessandro Russo (Author), Giancarlo Ceccarelli (Author), Valeria Bellelli (Author), Luigi Bianchi (Author), Federica Marincola Cattaneo (Author), Fabrizio Gregori (Author), Valeria Palmarini (Author), Nicola Marotta (Author), Alessandro Landi (Author), Alessandro Cuzzolino (Author), Matteo Stefanini (Author), Alessandro Aureli (Author), Claudio Maria Mastroianni (Author), Mario Venditti (Author), Gabriella d'Ettorre (Author), Francesco Sabetta (Author)
• Format: Book
• Published: MDPI AG, 2020-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/antibiotics9120889; 2079-6382
• Keywords: vertebral osteomyelitis; daptomycin; source control of infection; biofilm; clinical failure; Therapeutics. Pharmacology; RM1-950
• Source: Antibiotics, Vol 9, Iss 12, p 889 (2020)

Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians, because of its insidious and indolent course that makes diagnosis difficult. A concern is reported about the choice of antibiotic regimens, duration of therapy, and criteria to switch to oral therapy. We conducted a prospective observational study. All consecutive hospitalized patients with a confirmed diagnosis of VO caused by staphylococcal or enterococcal strains were analyzed. The primary endpoint was the analysis of clinical cure at the end of therapy. A propensity score for receiving therapy with daptomycin was added to the model. During the study period, 60 episodes of confirmed VO were observed. The main etiology of infection was methicillin-resistant Staphylococcus aureus (29%). Overall, clinical failure at end of therapy was reported in 11 (18.3%) patients. Logistic regression analysis, after propensity score, showed that >2 vertebrae involved (OR 2.4, CI95% 1.12-5.24, <i>p</i> = 0.002) and inadequate drainage of infection (OR 4.8, CI95% 2.45-8.51, <i>p</i> < 0.001) were independently associated with failure of therapy, while the use of a daptomycin-containing-regimen (OR 0.15, CI 95% 0.04-0.46, <i>p</i> < 0.001) with clinical cure. VO caused by staphylococcal or enterococcal strains is associated with an important rate of clinical failure. Daptomycin-containing regimen was strongly associated with clinical cure. Considering that over 70% of VO etiology is caused by Gram-positive strains but the etiology of infection is obtained in about 75% of cases, these data may help physicians to choose the appropriate antibiotic regimen.