Patients with concomitant renal disease may be more vulnerable to the development of nephrotoxicity associated with the introduction of vancomycin and the occurrence of therapeutic failure of bacteremia caused by Staphylococcus aureus. In light of recent data, the successful use of the combination of daptomycin + beta-lactam in severely treatable bacteremia caused by S. aureus.

In a multicentre study in the United States, safety and clinical outcomes were studied in patients who received daptomycin as monotherapy or in combination with beta-lactam for bacteremia caused by S. aureus .

The researchers identified 106 patients who received daptomycin for Staphylococcus aureus bacteremia and who had mild or moderate renal failure according to FDA criteria. These patients were included in the Cubicin registry and experience results (CORE), between 2005 and 2009. Favorable results with daptomycin were reported in 81% of the cases. The overall efficacy of the treatment was not much higher in the group in which the combination of daptomycin with beta-lactams was used (87% vs 78%, p = 0.336), however , this trend was mainly observed due to cases of bacteremia associated with endocarditis or infection of the bones and joints or bacteremia with an unknown source of infection (90% vs 57%, p = 0.061 ).

When using logistic regression, the factors associated with reduced efficacy of daptomycin therapy were found to be bacteremia of unknown source (odds ratio (OR) = 7.59, confidence interval ( 95% CI 1.55-37.2), moderately expressed impaired renal function (OS 9.11, 95% CI 1.46-56.8) and previous ineffectiveness of vancomycin therapy (OS 11.2, 95% CI 1.95 -64.5).

2 patients showed an increase in the level of creatine phosphokinase (CPK), which stopped after stopping the administration of daptomycin. None of the patients had renal impairment or the development of renal impairment associated with daptomycin.

Thus, daptomycin is an effective and well-tolerated antimicrobial drug in patients with bacteremia caused by S. aureus, and with concomitant mild to moderate renal impairment.

The effectiveness of daptomycin can be improved when used with beta-lactams in patients with bacteremia and endocarditis or bone and joint infection as the main focus of infection.