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CORRESPONDENCE
Year : 2012  |  Volume : 136  |  Issue : 4  |  Page : 676-677

Daptomycin susceptibility of methicillin resistant Staphylococcus aureus (MRSA)


1 Department of Biotechnology, Panjab University, Chandigarh 160 022, India
2 Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh 160 022, India

Date of Web Publication8-Nov-2012

Correspondence Address:
Vikas Gautam
3243 / 21-D, Chandigarh 160 022
India
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Source of Support: None, Conflict of Interest: None


PMID: 23168711

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How to cite this article:
Kaur R, Gautam V, Ray P, Singh G, Singhal L, Tiwari R. Daptomycin susceptibility of methicillin resistant Staphylococcus aureus (MRSA). Indian J Med Res 2012;136:676-7

How to cite this URL:
Kaur R, Gautam V, Ray P, Singh G, Singhal L, Tiwari R. Daptomycin susceptibility of methicillin resistant Staphylococcus aureus (MRSA). Indian J Med Res [serial online] 2012 [cited 2019 Oct 23];136:676-7. Available from: http://www.ijmr.org.in/text.asp?2012/136/4/676/103283

Sir,

Methicillin resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial and community acquired infections. There is a growing concern about MRSA with reduced susceptibility to vancomycin, which is currently the most extensively used antibiotic for its treatment [1],[2] . Many reports have stated discrepancies between in vitro susceptibility test results for vancomycin and clinical outcomes of MRSA infections treated with it [3] . This has made treatment of MRSA infections difficult due to limited antibiotic choices left. Thus, there is a need for evaluating newer agents as alternatives to vancomycin.

Daptomycin has been approved by Food and Drug Administration (FDA), USA in 2003 for the treatment of complicated skin and skin structure infections (cSSTI) and later for the treatment of S. aureus bacteraemia and right-sided endocarditis [3] . This drug causes myotoxicity and cannot be used in respiratory infections. In various clinical trials, daptomycin proved to be as effective as vancomycin against MRSA [1],[5] . We conducted this study to determine the in vitro activity of daptomycin against clinical isolates of MRSA obtained consecutively over a 6 month period beginning in January 2010. Sixty three MRSA, isolated from blood (33) and pus (30) in the department of Medical Microbiology, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, were included in this study. These isolates were identified using standard biochemical tests [6] and by oxacillin screen agar [7] .

E-test was done to determine minimum inhibitory concentration (MIC) to daptomycin for these MRSA strains using E strips (AB BIODISK Solna, Sweden) on Mueller-Hinton agar supplemented with 50 mg/l calcium (Difco, USA) due to daptomycin's dependence on calcium. S. aureus ATCC 29213 was also tested concurrently for quality control. The isolates were categorized as susceptible or resistant according to Clinical and Laboratory Standards Institute (CLSI) guidelines [7] .

The MIC value for S. aureus ATCC 29213 was within the range 0.25-1 μg/ml. All 63 clinical MRSA isolates were susceptible to daptomycin with MIC <1 μg/ml [Table 1]. At present, MRSA accounts for more than 60 per cent of S. aureus infections [8] . Johnson and colleagues [9] looked at the activity of daptomycin against multi-drug resistant isolates and found MIC for all organisms to be <1 mg/l. Daptomycin was also found active against strains resistant to linezolid and quinupristin/dalfopristin [10] . In one of the first reports from India [11] , in vitro activity of daptomycin and selected comparator agents was studied against S. aureus and vancomycin resistant Enterococcus faecium (VRE) isolates recovered from hospitalized patients with SSTI. Daptomycin was the most active agent against both S. aureus (MIC 90 , 1 μg/ml; 100% susceptible) and VRE (MIC 90 , 4 μg/ml; 100% susceptible), highlighting the importance of the drug as an excellent therapeutic option.
Table 1: Distribution of the MICs for daptomycin determined by E-test for 63 isolates of MRSA

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Daptomycin was found to be highly active against all the MRSA isolates tested suggesting that daptomycin testing to be included in routine S. aureus susceptibility testing panel. It could be an alternative to vancomycin in the treatment of MRSA infections for which it is not possible to use it due to resistance or nephrotoxicity [3],[4] . Considering its safety profile and rapid bactericidal action, and also ease of administration with once daily dose, daptomycin may be useful for the treatment of severe infection caused by MRSA.

 
   References Top

1.Moore CL, Osaki-Kiyan P, Haque NZ, Perri MB, Donabedian S, Zervos MJ. Daptomycin versus vancomycin for bloodstream infections due to methicillin-resistant Staphylococcus aureus with a high vancomycin minimum inhibitory concentration: a case-control study. Clin Infect Dis 2012; 54 : 51-8.  Back to cited text no. 1
[PUBMED]    
2.Leonard SN, Rybak MJ. Evaluation of vancomycin and daptomycin against methicillin-resistant Staphylococcus aureus and heterogeneously vancomycin-intermediate S. aureus in an in vitro pharmacokinetic/pharmacodynamic model with simulated endocardial vegetations. J Antimicrob Chemother 2009; 63 : 155-60.  Back to cited text no. 2
[PUBMED]    
3.Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC, Jr., Eliopoulos GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2004; 42 : 2398-402.  Back to cited text no. 3
    
4.Sauermann R, Rothenburger M, Graninger W, Joukhadar C. Daptomycin: a review 4 years after first approval. Pharmacology 2008; 81 : 79-91.  Back to cited text no. 4
    
5.Levine DP. Clinical experience with daptomycin: bacteraemia and endocarditis. J Antimicrob Chemother 2008; 62 (Suppl 3): iii35-9.  Back to cited text no. 5
    
6.Baird D. Staphylococcus: cluster-forming Gram-positive cocci. In: Collee AG, Fraser BP, Marmion JG, Simmons A, editors. Mackie & McCartney practical medical Microbiology, 14 th ed. New York: Churchill Livingstone, 1996. p. 245-61.  Back to cited text no. 6
    
7.Performance standards for antimicrobial susceptibility testing; 20 th informational supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.  Back to cited text no. 7
    
8.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32 : 470-85.  Back to cited text no. 8
    
9.Johnson AP, Mushtaq S, Warner M, Livermore DM. Activity of daptomycin against multi-resistant Gram-positive bacteria including enterococci and Staphylococcus aureus resistant to linezolid. Int J Antimicrob Agents 2004; 24 : 315-9.  Back to cited text no. 9
    
10.Rybak MJ, Hershberger E, Moldovan T, Grucz RG. In vitro activities of daptomycin, vancomycin, linezolid, and quinupristin-dalfopristin against Staphylococci and Enterococci, including vancomycin- intermediate and -resistant strains. Antimicrob Agents Chemother 2000; 44 : 1062-6.  Back to cited text no. 10
    
11.Dhawan B, Gadepalli R, Kapil A. In vitro activity of daptomycin against Staphylococcus aureus and vancomycin-resistant Enterococcus faecium isolates associated with skin and soft tissue infections: first results from India. Diagn Microbiol Infect Dis 2009; 65 : 196-8.  Back to cited text no. 11
    



 
 
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