Document Type

Article

Abstract

Enterococci are among the leading pathogens isolated in hospital-acquired infections. Current antimicrobial options for vancomycin-resistant enterococci (VRE) are limited. Prior data suggests that daptomycin > 6mg/kg/day may be used to treat enterococcal infections. We retrospectively evaluated the effectiveness and safety of high-dose daptomycin (HD-daptomycin) therapy (> 6 mg/kg) in a multicenter cohort of adult patients with enterococcal infections to describe the characteristics and outcomes. Two-hundred and forty-five patients were evaluated. Enterococcus faecium was identified in 175 (71%), followed by 49 (20%) Enterococcus faecalis and 21 (9%) Enterococcus spp., overall 204 (83%) were VRE. Enterococcal infections included bacteremia (173, 71%), intra-abdominal (35, 14%) and bone/joint (25, 10%). The median dose and duration of HD-daptomycin was 8.2 mg/kg/day (IQR 7.7-9.7) and 10 days (IQR 6-15), respectively. Overall clinical success rate was 89% (193/218) and microbiological eradication was observed in 93% (177/191) of patients. The median time to clearance of blood cultures on HD-daptomycin was 3 days (IQR 2-5). Thirty-day all cause mortality rate was 27% and 5 (2%) patients developed daptomycin nonsusceptible enterococcal strains while on HD-daptomycin. Seven patients (3%) had creatine phosphokinase (CPK) elevation, yet no HD-daptomycin regimen was discontinued due to an elevated CPK and all patients were asymptomatic. Overall, there was a high frequency of clinical success and microbiological eradication in patients treated with HD-daptomycin for enterococcal infections, even in patients with complicated and difficult to treat infections. No adverse event-related discontinuation of HD-daptomycin was noted. HD-daptomycin may be an option for the treatment of enterococcal infections.

Disciplines

Bacterial Infections and Mycoses | Chemicals and Drugs | Hematology | Infectious Disease | Medicine and Health Sciences

Comments

NOTICE IN COMPLIANCE WITH PUBLISHER POLICY: This is the author’s final manuscript version, post-peer-review, of a work accepted for publication in Antimicrobial Agents and Chemotherapy. Changes resulting from the publishing process may not be reflected in this document; changes may have been made to this work since it was submitted for publication. This version has been formatted for archiving; a definitive version was subsequently published in Antimicrobial Agents and Chemotherapy, 57(9): 4190-4196 (September 2013) http://dx.doi.org/10.1128/AAC.00526-13

Additional Files
Supplementary Table 1.pdf (15 kB)
Supplementary Table 1
HD Dapto Enterococci Study Manuscript 3-14-13 AAC Format[1].docx (336 kB)
Author's unformatted final accepted manuscript
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