Daptomycin: graduation day

ABSTRACTGram-positive infections, both community- and hospital-acquired, have a huge impact on healthcare. The incidence of Staphylococcus aureus bacteraemia is on the increase, probably due to the rising numbers of patients with risk-factors for these infections. Antibiotic resistance has seriously compromised treatment options for Gram-positive infections, most notably those caused by staphylococci and enterococci. Until recently, methicillin-resistant S. aureus (MRSA) was observed mainly in healthcare-associated infections, but a significant rise in community-associated MRSA is being reported, especially in the USA. In the last decade, vancomycin-resistant enterococci (VRE) have become the second most important group of pathogens among intensive care patients in US hospitals, and VRE outbreaks are currently emerging in European hospitals. The changing patterns of both MRSA and VRE are associated with a changing molecular epidemiology, in which sub-populations with obvious enhanced epidemic potential are rapidly becoming more prominent. These recent epidemiological observations suggest an increase in difficult-to-treat Gram-positive infections in European hospitals in the coming years, and underscore the need for new treatment options. Daptomycin, the first cyclic lipopeptide, is a novel antibiotic with potent in-vitro activity against Gram-positive organisms, including MRSA and VRE. It has been approved for the treatment of complicated skin and soft tissue infections caused by Gram-positive bacteria, and registration for treatment of infective endocarditis and bacteraemia is anticipated. The novel mode of action, rapid in-vitro bactericidal activity against growing and stationary-phase bacteria, once-daily dosing regimen, and no requirement for drug monitoring, could all make daptomycin an attractive option for the treatment of Gram-positive infections.