Safety of Daptomycin in Patients Receiving Hemodialysis

Study Objective. To determine the safety of daptomycin administered using a variety of doses and dosing frequencies in patients receiving intermittent hemodialysis who had probable or confirmed gram‐positive infections. Design. Analysis of data from the Cubicin Outcomes Registry and Experience (CORE), a multicenter, retrospective, observational registry. Setting. Fifty‐four study sites, mostly (46%) large teaching hospitals. Patients. Three hundred ninety‐three adults in the CORE registry who received intermittent hemodialysis between 2005 and 2008. Measurements and Main Results. The CORE registry is noninterventional and collects standard‐of‐care data on daptomycin treatment from health care institutions. Of the 393 patients, 370 (94%) could be categorized by daptomycin dosing frequency: every 48 hours (251 patients [64%]), 3 times/week (87 [22%]), and every 24 hours (32 [8%]); the remaining 23 (6%) had unreported dosing frequencies or received a single dose of daptomycin. Three hundred eighty‐four patients (98%) received part of their daptomycin therapy as an inpatient and 129 patients (33%) received part of their daptomycin therapy in an intensive care setting. The primary infection type was bacteremia (224 patients [57%]), and the most common pathogen was Staphylococcus aureus (155 patients [39%]). Thirty‐eight adverse events possibly related to daptomycin occurred in 28 patients (7%); increased blood creatine kinase level (7 patients [1.8%]) was the most common adverse event. Adverse‐event rates were similar across all dosing regimens. Conclusion. In these patients undergoing hemodialysis, daptomycin was a well‐tolerated treatment for gram‐positive infections across several doses and dosing frequencies. Further study in prospective trials is warranted.