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Daptomycin monotherapy in the treatment of vancomycin-resistant enterococcal bacteraemia

Abstract number: R2353

Gallagher J.C., Perez M.E., Rose C.M., Abrardo L., Marino E., Walker M.

Objectives: Daptomycin (DAP) is indicated for Staphylococcus aureus bacteraemia, but has not been sufficiently studied in bacteraemia caused by vancomycin-resistant enterococci (VRE), a difficult-to-study disease state common in the intensive care unit (ICU). The aim was to retrospectively evaluate DAP monotherapy in patients with VRE bacteraemia.

Methods: We performed a retrospective study of patients treated for VRE bacteraemia between January 2004 and July 2007 by reviewing medical records. Patients were included if they received DAP monotherapy and had a blood culture positive for VRE at the time DAP was started. Patients receiving concurrent antibiotics for VRE bacteraemia and those with negative blood cultures prior to receiving DAP were excluded. The primary endpoint was microbiological cure, defined as negative blood cultures for VRE at the end of therapy. Clinical outcomes at the end of therapy were also evaluated with standardised definitions and adverse events were assessed: cure or improvement were considered positive, and worsening or death within 7 days of the end of DAP therapy were considered negative. Descriptive statistics were used and data are reported as median (range), except where noted.

Results: 31 patients were included. DAP was initiated 23 days (1–281 days) into the hospital stay, for a duration of 13 days (1–42 days). 20/31 patients (64.5%) were in the ICU when presentation of bacteraemia occurred, with an ICU stay of 35 days (2–298 days). Prior to DAP therapy, bacteraemia was present for 3 days (0–7 days) without effective therapy for VRE (i.e. no antibiotics active against VRE, or linezolid failure occurred). Enterococcus faecium was cultured 28 times, E. faecalis was cultured 5 times, and E. raffinosus was cultured once; 3 patients had multiple species cultured. All isolates tested were susceptible to DAP. The dose given was 6 mg/kg (4.0–6.7 mg/kg). Blood cultures tested negative 2 days (0–24 days) after initiation of DAP therapy. Microbiologic eradication was observed in 25 patients (80.6%) and positive clinical outcomes were seen in 18 patients (58.1%). Mild creatine phosphokinase (CPK) elevations were seen in only two patients (CPK 243 U/L and 252 U/L; normal range 20–230 U/L) and both spontaneously resolved while on DAP.

Conclusion: In this descriptive study, DAP monotherapy was effective in clearing bacteraemia caused by VRE.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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