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Indian Journal of Medical Microbiology, Vol. 30, No. 1, January-March, 2012, pp. 114-115 Correspondence In vitro study to evaluate the sensitivity to daptomycin among gram positive clinical isolates K Padmaja, P Umabala, KSRK Prasad, V Lakshmi Department of Microbiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, Andhra Pradesh, India Correspondence Address: Date of Acceptance: 01-Nov-2011 Code Number: mb12028 PMID: 22361779 DOI: 10.4103/0255-0857.93088 Dear Editor, Gram positive bacteria are a major cause of serious infections such as complicated skin and soft tissue infections, bacteraemia and infective endocarditis. Infecting organisms include resistant pathogens such as methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococci (VRE) which have become a major concern over the last decade. Antibiotics such as glycopeptides (vancomycin and teicoplanin) and the oxazolidinone (linezolid) are being effectively used for treatment of such infections. However, the growing resistance among these organisms indicates a need for newer antimicrobials. [1] Daptomycin, a fermentation product produced by Streptomyces roseosporus, a cyclic lipopeptide, is a potential novel antibiotic for the treatment of skin and soft tissue Gram positive infections. [2] In vitro time kill studies found Daptomycin to be rapidly bactericidal against the majority of organisms tested, killing 99.9% of bacteria within 6 h. [1] This novel antimicrobial was approved by the United States Food and Drug administration (US-FDA) in 2003, to be administered intravenously at the dose of 4 mg/kg of body weight/day for the treatment of complicated skin and soft tissue infections (cSSSI) , blood stream infections and infective endocarditis caused by MRSA, S.pyogenes, S. agalactiae and Enterococcus species.[1] The rapid bactericidal activity of daptomycin makes it an attractive antibiotic for serious Gram positive infections, including multidrug resistant strains such as MRSA and VRE.[1] With the features of rapid bactericidal activity, low potential for resistance and promising safety profile, prolonged antibiotic effect and daily dosing regimen, daptomycin is considered as an equivalent to vancomycin. [2] The in vitro antimicrobial activity and the minimum inhibitory concentration (MIC) of daptomycin was compared with vancomycin, teicoplanin and linezolid against 90 Gram positive bacterial isolates obtained from skin and soft tissue infections and blood stream infections, recovered from blood, pus and wound material, using the E test method. Prospectively study was performed on 90 consecutive Gram positive clinical isolates recovered from blood, pus and wound material. All the isolates were identified by the Vitek 2 using the GP ID panel (bio Merieux, F-69280 Marcy l'Etoile,France). The MICs of all the isolates were determined by the E; test (AB Biodisk, Solna, Sweden) as per CLSI. [3] (Clinical and Laboratory Standards Institute). The E test daptomycin strip comprises a predefined gradient of daptomycin (0.016-256 μg/ml) overlaid with a constant level of calcium to achieve an equivalent of 40 μg/ml of Ca +2 and was tested on plain Mueller Hinton agar (MHA) (Difco, BD, Sparks, MD 21152, USA) supplemented with 2% NaCl for MRSA and methicillin resistant coagulase negative Staphylococci (MRCONS), plain MHA for Enterococcus spp and sheep blood agar (COS, bio Merieux, F-69280 Marcy l'Etoile, France) for Streptococcus pyogenes. MRSA (ATCC 43300) and Enterococcus faecalis (ATCC 29212) were used as control strains. All the 90 Gram positive isolates were sensitive to all the four study drugs with the MIC ranges within the CLSI breakpoints. [3] This in vitro study, one of the few studies available from India, demonstrates that daptomycin is an efficient antimicrobial against all the Gram positive pathogens. Other centres from India showed that daptomycin was the most active agent against both S. aureus and VRE[4] and daptomycin has potent activity against all the Gram positive isolates obtained from skin and soft tissue infections in trauma patients. [5] With limited therapeutic options for Gram positive infections and the potential threat of development of resistance among Gram positive isolates newer antibiotics like daptomycin, could be an efficient and appropriate alternate drug especially in the treatment of skin and soft tissue infections and blood stream infections. References
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