Daptomycin versus beta-lactam based therapy for the treatment of enterococcal endocarditis and other endovascular infections: a retrospective cohort study.

BACKGROUND

Daptomycin has a favorable efficacy and safety profile against enterococcal infections, but it is currently a last line treatment for enterococcal infective endocarditis (EIE) due to limited evidence supporting its use.

METHODS

This study aimed to investigate clinical outcomes among patients with EIE who received daptomycin versus beta-lactam based therapy. This was a single-center, retrospective cohort study of hospitalized patients with documented EIE and definitive treatment with daptomycin or beta-lactam based therapy between 2011 and 2023. The primary outcome was clinical failure (composite of inpatient infection-related mortality and progression of disease leading to change in therapy). Descriptive statistics assessed baseline demographics, clinical data, and outcomes between patients who received daptomycin versus beta-lactams.

RESULTS

Twenty-six patients receiving daptomycin (median 10 mg/kg/dose) were compared to 102 receiving beta-lactam based therapy (81% ampicillin and ceftriaxone). No significant difference in clinical failure was observed between groups (0% daptomycin vs. 6% beta-lactam; p = 0.35). Individual components of the primary outcome, all-cause mortality, and adverse events leading to therapy discontinuation were similar between groups.

CONCLUSIONS

Outcomes were similar among patients with EIE treated with daptomycin versus beta-lactams. Larger, prospective studies are needed to confirm this finding.