Please cite this article in press as: Falcone M, et al. Retrospective case–control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy. Int J Antimicrob Agents (2011), doi:10.1016/j.ijantimicag.2011.09.011 ARTICLE IN PRESS G Model ANTAGE-3703; No. of Pages 5 International Journal of Antimicrobial Agents xxx (2011) xxx–xxx Contents lists available at SciVerse ScienceDirect International Journal of Antimicrobial Agents jou rn al h om epa ge: h ttp://www.elsevier.com/locate/ijantimicag Retrospective case–control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy Marco Falcone a,∗ , Alessandro Russo a , Maria Elena Pompeo a , Antonio Vena a , Laura Marruncheddu b , Antonio Ciccaglioni b , Paolo Grossi c , Carlo Mancini a , Andrea Novelli d , Stefania Stefani e , Mario Venditti a a Department of Public Health and Infectious Diseases, Policlinico Umberto I, ‘Sapienza’ University of Rome, Viale dell’Università 37, 00161 Rome, Italy b Department of Cardiovascular Diseases, Policlinico Umberto I, ‘Sapienza’ University of Rome, Rome, Italy c Infectious and Tropical Diseases Unit, Department of Transplantation, University of Insubria–Ospedale di Circolo e Fondazione Macchi, Varese, Italy d Department of Pharmacology, University of Florence, Florence, Italy e Department of Pharmacology, University of Catania, Catania, Italy a r t i c l e i n f o Article history: Received 23 June 2011 Accepted 5 September 2011 Keywords: Daptomycin Vancomycin Teicoplanin Bloodstream infections Skin and soft-tissue infections Staphylococcus aureus Coagulase-negative staphylococci a b s t r a c t Glycopeptides have been considered the antimicrobials of choice for serious meticillin-resistant Staphy- lococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) infections for several years. Daptomycin is a new option for the treatment of these infections, including those exhibiting reduced susceptibility to glycopeptides. The aim of this study was to compare glycopeptides and daptomycin for the treatment of infections caused by MRSA or MR-CoNS. Data for 106 patients with bloodstream infections (bacteraemia or infective endocarditis) or skin and soft-tissue infections (SSTIs) were retrospectively reviewed, of which 43 were treated with daptomycin (DAP group) and 63 were treated with vancomycin or teicoplanin (GLYCO group). Patients included in the two comparison groups were homogeneous in terms of age, risk factors and clinical severity. Aetiology was mainly rep- resented by MRSA in both groups, followed by various species of MR-CoNS. Daptomycin was used more frequently in patients with central venous catheter-associated bacteraemia or pacemaker-associated infection. Patients with SSTIs included in the GLYCO group had a longer mean duration of antibiotic ther- apy (18.2 days vs. 14.6 days; P = 0.009) and a longer mean length of hospital stay (28.2 days vs. 19.6 days; P = 0.01) compared with those included in the DAP group. A longer mean duration of antibiotic therapy was also observed in patients with bloodstream infections receiving glycopeptide therapy (25.6 days vs. 18 days; P = 0.004). In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting. © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. 1. Introduction Meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) are well-recognised causes both of community-acquired and healthcare-associated infections [1–4]. Glycopeptides have been considered the antimicrobials of choice for serious MRSA and/or MR-CoNS infections for several years [5]. However, during the last decades reports of treatment failures involving isolates presum- ably susceptible to glycopeptides have become more common. Evidence of a significant relationship between higher vancomycin minimum inhibitory concentrations (MICs) in the range 1–2 mg/L ∗ Corresponding author. Tel.: +39 06 494 0421; fax: +39 06 4997 2625. E-mail address: marcofalc@libero.it (M. Falcone). and treatment failure have led to calls for alternative therapies in these cases [6–8]. Daptomycin, a lipoglycopeptide agent that is rapidly bacterici- dal, is an alternative option for the treatment of infections caused by meticillin-resistant staphylococci, including isolates exhibit- ing reduced susceptibility to glycopeptides. Its use is approved in patients with bacteraemia, infectious endocarditis (IE) and com- plicated skin and soft-tissue infections (SSTIs) [9,10]. The aim of the present retrospective study was to compare the clini- cal outcomes of patients with bacteraemia, IE or SSTI caused by meticillin-resistant staphylococci treated with daptomycin or with a glycopeptide such as vancomycin or teicoplanin. 2. Materials and methods This retrospective, case–control analysis was conducted in the University Hospital Umberto I (Rome, Italy) during the period 0924-8579/$ – see front matter © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. doi:10.1016/j.ijantimicag.2011.09.011