Table 4.

Clinical summary of cases of S. aureus bacteremia and mild or moderate renal insufficiency that were classified as daptomycin treatment failures^a

Patient no.	Age range (yr), sex	Underlying condition(s)	MRSA or MSSA, BSI source	Antibiotics received prior to DAP	DAP therapy	Comments
1	>80, M	Neutropenia (ANC, <100), HTN, CV disease, COPD, anemia, acute kidney injury, solid organ malignancy	MRSA, central catheter	VAN	6 mg/kg q24h for 4 days	Switched to alternative therapy; expired after DAP therapy; infected central catheter (Port-A-Cath) not removed
2	>80, F	CHF, CV disease	MRSA, biomedical device infection	VAN (treatment failure)	7 mg/kg q48h for 3 days (CLCR of <30 ml/min)	Medical care was withdrawn after 3 days of DAP; infected biomedical device not removed
3	>80, M	CV disease	MRSA, biomedical device infection	VAN (treatment failure)	8 mg/kg q48h for 7 days (CLCR of <30 ml/min) + RIF	No documentation of device removal; recurrence 10 days after DAP was discontinued; DAP MIC, >3 μg/ml; patient received LZD + ampicillin-sulbactam + RIF
4	66–80, M	HTN	MSSA, unknown source	VAN	4 mg/kg q48h for 2 days (CLCR of <30 ml/min)	DAP dose less than FDA-recommended dose
5	51–65, M	DM, CV disease, CHF, GI bleed	MRSA, unknown source	VAN	3.7 mg/kg, then 5.7 mg/kg q48h for 32 days	DAP dose less than FDA-recommended dose; concomitant vancomycin-resistant Enterococcus faecium bacteremia; patient expired after DAP was discontinued
6	51–65, F	HTN	MSSA, unknown source	Failed antibiotics other than VAN	6 mg/kg q24h for 7 days + RIF	Clinical response was unknown/lost to follow-up, deemed a failure
7	>80, F	DM, HTN	MRSA, unknown source	Received prior antibiotic for BSI, other than VAN	5 mg/kg q24h for 9 days	Dose less than FDA-recommended dose; patient expired after DAP was discontinued
8	66–80, M	DM, HTN, PVD, PE/DVT, acute kidney injury	MRSA, left-sided IE	VAN (treatment failure)	6 mg/kg q48h for 58 days (CLCR of <30 ml/min) + RIF	No surgical intervention; aortic valve involved
9	66–80, M	BPH	MRSA, left-sided IE	VAN (treatment failure)	4 mg/kg for 1 day	Dose less than that recommended by most experts; surgical intervention not documented
10	31–50, F	Acute kidney injury, hematologic malignancy	MRSA, central catheter	VAN (treatment failure)	6 mg/kg q48h for 10 days (CLCR of <30 ml/min)	Prior VAN failure; no documentation of catheter removal during DAP therapy
11	51–65, F	Sepsis/septicemia, acute coronary syndrome, CV disease, CHF, HTN	MSSA, unknown source	None	4 mg/kg q48h (CLCR of <30 ml/min)	DAP dose less than FDA-recommended dose; therapy was switched; patient expired after DAP was discontinued
12	66–80, M	Cardiac arrhythmias, HTN, COPD	MRSA, right-sided IE	VAN	6 mg/kg q48h for 7 days + GEN + RIF	Patient expired during DAP therapy; no surgery documented
13	51–65, M	HTN, liver disease	MSSA, unknown source	VAN	6 mg/kg q24h for 2 days + GEN	After 2 days of DAP, therapy was switched to an alternative regimen
14	66–80, F	DM, HTN, PVD	MRSA, OM	VAN (treatment failure)	6 mg/kg q24h for 9 days	Surgical intervention performed; DAP was discontinued because the case was deemed a DAP treatment failure
15	>80, M	CV disease, anemia/hematologic disease, solid organ malignancy	MRSA, unknown source	VAN (treatment failure)	6 mg/kg q24h for 5 days	Patient expired after 5 days of DAP therapy

^aANC, absolute neutrophil count; BPH, benign prostatic hypertrophy; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; DAP, daptomycin; DM, diabetes mellitus; F, female; GEN, gentamicin; GI, gastrointestinal; HTN, hypertension; IE, infective endocarditis; LZD, linezolid; M, male; OM, osteomyelitis; PE/DVT, pulmonary embolism and deep vein thrombosis; PVD, peripheral vascular disease; RIF, rifampin; VAN, vancomycin.