Daptomycin in the Treatment of Catheter-Related Staphylococcus Aureus

Inclusion Criteria:

1. Male or non-pregnant, non-lactating females with an age of greater than or equal to 18 years.
2. The suspected culprit on exchangeable CVC is tunnel ( including implanted ports) or non-tunneled catheter, antibiotic or non-antibiotic coated catheter inserted in the subclavian, jugular or femoral vein.
3. Patients must have at least two signs of sepsis from the list below, in any combination, within 48 hours prior to Daptomycin therapy and no other source for the bacteremia other than CVC: (a) Core temperature =/>38.0 degrees C or =/<36.0 degrees C, measured orally, rectally, tympanically or via a central catheter. If axillary add 0.5 degrees C to the measured temperature; (b) Pulse rate =/> 100 beats/min.; (c) Respiratory rate =/> 20/min; (d) WBC count =/>12,000/mm^3 or =/<4,000/mm^3 differential count showing >10% band forms; (e) Systolic blood pressure=/ <90 mm Hg
4. Patients with suspected or definite diagnosis of uncomplicated CVC-related gram-positive bacteremia that includes at least one positive blood culture for S aureus. (If the positive blood culture is drawn through the CVC, then at least >15 colonies/ml will be required or the differential time of positive ( DTP) of CVC at least 2 hours earlier than the peripheral culture)
5. Signed informed consent
6. No apparent source for the clinical manifestation of bacteremia other than the catheter

Exclusion Criteria:

1. Creatinine clearance <30 mL/min at the time gram positive bacteremia was diagnosed unless the patient is on dialysis
2. Bilirubin >4x the upper limit of normal at the time gram positive bacteremia was diagnosed
3. Treatment with an antibiotic effective against Gram-positive bacterial infections for more than 48 hours within 72 hours of study medication initiation, unless treatment failed.
4. Documented S. aureus bacteremia within last 3 months due to source other than CVC.
5. Patients who have participated in another investigational anti-infective study within 30 days
6. History of hypersensitivity to lipopeptides
7. Presence of additional source of infection with same organism cultured from blood, eg. endocarditis (as evidenced by vegetations on an echocardiogram), septic thrombosis
8. Conditions with markedly decreased albumin in plasma (<1.5 g/dl), e.g., cirrhosis, nephritic syndrome, end-stage renal disease
9. Anticipated prolonged therapy >4 weeks
10. Prosthetic endovascular material
11. Oliguria defined as urine output of <20 cc/hour averaged over 24 hours.
12. Possible complicated CRBSI with persistent bacteremia for more than 48 hours on active antimicrobial therapy (such as osteomyelitis, endocarditis, and septic thrombosis.)
13. Evidence of catheter site purulence as evidenced by purulent discharge.
14. Patients with diagnosis of pneumonia that is related to S. aureus organism
15. Patients taking concomitant "statins" (HMG-CoA reductase inhibitors)
16. CPK >10X max-normal in asymptomatic patients and CPK >5 max-normal in symptomatic patients.