J Bone Jt Infect 2020; 5(2):82-88. doi:10.7150/jbji.41278

Research Paper

Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection

Alberto V. Carli1✉, Andy O. Miller2, Milan Kapadia2, Yu-fen Chiu1, Geoffrey H. Westrich1, Barry D. Brause2, Michael W. Henry2

1. Hospital for Special Surgery, Division of Adult Reconstruction & Joint Replacement, 535 East 70 th Street, New York, NY 10065, USA
2. Hospital for Special Surgery, Infectious Disease Division, 535 East 70 th Street, New York, NY 10065, USA

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Citation:
Carli AV, Miller AO, Kapadia M, Chiu Yf, Westrich GH, Brause BD, Henry MW. Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection. J Bone Jt Infect 2020; 5(2):82-88. doi:10.7150/jbji.41278. Available from http://www.jbji.net/v05p0082.htm

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Abstract

Background: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin.

Methods: A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI. The primary endpoint was 2 year prosthesis retention. Univariate analyses and regression statistics were calculated.

Results: 341 patients with staphylococcal PJI were analyzed. 154 two-stages (77%) and 74 DAIR procedures (52%) met criteria for treatment success at 2 years. 77 patients were treated with daptomycin, of which 34 two-stages (68%) and 15 DAIRs (56%) achieved treatment success. Pairwise and regression analysis found no association between treatment success and daptomycin use. Organism (DAIR only) and Charlson Comorbidity Index scores (DAIR and two-stage) were significantly associated with treatment outcome. Six daptomycin patients (7.8%) had adverse side effects.

Discussion: Daptomycin fared no better or worse than comparable antibiotics in a retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy.

Conclusion: The convenient dosing, safety, and potency of daptomycin make it an attractive antibiotic for staphylococcal PJI. However, these advantages must be weighed against higher costs and rare, but serious side effects.

Keywords: prosthetic joint infection, daptomycin, antibiotics, revision arthroplasty, implant retention, staphylococcal