Effect of daptomycin on local interleukin-6, matrix metalloproteinase-9, and metallopeptidase inhibitor 1 in patients with MRSA-infected diabetic foot.

Infection is a major cause of the diabetic foot syndrome being aggravating by the increased burden of multiresistant germs like methicillin-resistant Staphylococcus aureus (MRSA). Maximizing positive outcome for serious MRSA infections requires an aggressive treatment approach and a careful monitoring of the healing process. Therefore, we examined 8 patients with MRSA-infected diabetic foot syndrome Wagner classification grades 2 or 3 (corresponding to the Texas classification stage 2 and 3) during antibiotic treatment with daptomycin. We documented the wound size and obtained samples of wound secretion for analyses of pro-inflammatory interleukin-6 (IL-6), protease (matrix metalloproteinase-9 [MMP-9]), and antiprotease activity (metallopeptidase inhibitor 1 [TIMP-1]). During the course of anti-MRSA therapy, a decrease in the concentration of local IL-6 within the first 3 days followed by a drop of MMP-9 and an increase of TIMP-1 was observed. Finally, a reduction of wound size could be documented. The present data show that efficient antimicrobial treatment with daptomycin leads to a number of beneficial processes at the molecular level of wound healing in MRSA-infected diabetic foot ulcers.