Real-world daptomycin use across wide geographical regions: results from a pooled analysis of CORE and EU-CORE

摘要

Background Pooled data from two large registries, Cubicin? Outcomes Registry and Experience (CORE; USA) and European Cubicin? Outcomes Registry and Experience (EU-CORE; Europe, Latin America, and Asia), were analyzed to determine the characteristics and clinical outcomes of daptomycin therapy in patients with Gram-positive infections across wide geographical regions. Methods Patients receiving at least one dose of daptomycin between 2004 and 2012 for the treatment of Gram-positive infections were included. Clinical success was defined as an outcome of ‘cured’ or ‘improved’. Post-treatment follow-up data were collected for a subset of patients (CORE: osteomyelitis and orthopedic foreign body device infection; EU-CORE: endocarditis, intracardiac/intravascular device infection, osteomyelitis, and orthopedic device infection). Safety was assessed for up to 30?days after daptomycin treatment. Results In 11,557 patients (CORE, 5482; EU-CORE, 6075) treated with daptomycin (median age, 62 [range, 1–103] years), the most frequent underlying conditions were cardiovascular disease (54.7?%) and diabetes mellitus (28.0?%). The most commonly treated primary infections were complicated skin and soft tissue infection (cSSTI; 31.2?%) and bacteremia (21.8?%). The overall clinical success rate was 77.2?% (uncomplicated SSTI, 88.3?%; cSSTI, 81.0?%; osteomyelitis, 77.7?%; foreign body/prosthetic infection (FBPI), 75.9?%; endocarditis, 75.4?%; and bacteremia, 69.5?%). The clinical success rate was 79.1?% in patients with Staphylococcus aureus infections (MRSA, 78.1?%). An increasing trend of high-dose daptomycin (>6?mg/kg/day) prescribing pattern was observed over time. Clinical success rates were higher with high-dose daptomycin treatment for endocarditis and FBPI. Adverse events (AEs) and serious AEs possibly related to daptomycin therapy were reported in 628 (5.4?%) and 133 (1.2?%) patients, respectively. Conclusions The real-world data showed that daptomycin was effective and safe in the treatment of various Gram-positive infections, including those caused by resistant pathogens, across wide geographical regions.