Metrics details. Even if daptomycin does not have approval for the treatment of bone and joint infections BJI , the Infectious Diseases Society of America guidelines propose this antibiotic as alternative therapy for prosthetic joint infection. Factors associated with treatment failure were determined on univariate Cox analysis and Kaplan-Meier curves. Predictors for treatment failure were age, non-optimal surgery and daptomycin withdrawal for SAE.
Prolonged high-dose daptomycin therapy was effective in patients with complex BJI. However, optimal surgery remains the cornerstone of medico-surgical strategy; and a higher incidence of eosinophilic pneumonia than expected was recorded. Peer Review reports. Bone and joint infections BJI include very heterogeneous clinical entities, with different therapeutic strategies and prognoses.
Some, such as uncomplicated childhood osteomyelitis, are easy to treat, as short-course antimicrobial therapy without surgery is classically associated with excellent prognosis. In contrast, in some situations such as chronic implant-associated BJI, the pathogen is difficult to eradicate, leading to high rates of relapse and morbidity despite aggressive surgical strategy and prolonged intravenous antibiotic therapy.
In such cases, team-work in tertiary care centers is required to determine optimal surgical management so as to limit treatment failure, motor disability and risk of amputation.
The choice of antimicrobial therapy is also challenging, requiring consideration of: i the problem of bone diffusion [ 1 ]; ii the necessity of using antimicrobials active against bacterial biofilms [ 2 ]; iii the growing incidence of antibiotic resistance; and iv the high risk of severe adverse events SAE in response to first-line antimicrobials in these patients [ 3 ]. Consequently, off-label use of recently developed antimicrobials, such as daptomycin, is frequently required as salvage therapy in complex BJI.
