321. Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection

Background Optimal antibiotic therapy following surgery for prosthetic joint infection (PJI) depends on potency, toxicity, convenience, and cost. Daptomycin, a potent, convenient, and low-toxicity antibiotic, is FDA approved for the treatment of skin and soft-tissue infections, but its role in treatment of PJI is less clear. We reviewed our experience with daptomycin in the treatment of staphylococcal PJI. Methods A retrospective cohort of staphylococcal hip and knee PJI treated with daptomycin after debridement (I&D) or two-stage exchange was identified by query of hospital coding records from 2009 to 2014, with subsequent chart review. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI; all staphylococcal species were included. The primary endpoint was defined in debrided joints as retention of the prosthesis at 2-year follow-up, and for two-stage exchanges, as prosthesis retention for 2 years from reimplantation. Descriptive statistics were completed using the Fisher’s exact test for categorical variables and the Mann–Whitney U test for continuous variables. Results Two hundred forty-one patients with staphylococcal PJI were identified: 148 two-stages (112 [75%] had success at 2 years) and 95 I&Ds (44 [47%] had success at 2 years. Twenty-eight (19%) two-stages and nine (10%) of debridements received daptomycin; of which, 20 two-stages (72%) and six debridements (66%) reached a successful 2-year outcome. In univariate analysis, there was no association between success and receipt of daptomycin in patients with staphylococcal PJI (two-stages, P = 0.71; debridement, P = 0.63). There were no associations noted between outcome and age, sex, or BMI. Conclusion Daptomycin appeared no better or worse than comparator antibiotics in a relatively large retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy. Given its favorable convenience and toxicity profile, it is an attractive antibiotic choice for staphylococcal PJI despite its high cost. Disclosures All authors: No reported disclosures.