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Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients
Debra D Poutsiaka1, Serena Skiffington, Kenneth B Miller
1Division of Geographic Medicine and Infectious Diseases, Box 041, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA. dpoutsiaka@tufts-nemc.org <dpoutsiaka@tufts-nemc.org>
Objective:
Vancomycin resistant enterococcal (VRE) blood stream infection (BSI) in neutropenic patients is associated with poor outcome. We report our experience in treating VRE BSI in febrile, neutropenic patients with daptomycin, a recently licensed lipopeptide with bactericidal activity against VRE.
Patients And Methods:
Patients with fever, neutropenia and VRE BSI were treated with more than one dose of daptomycin (either 6 mg/kg/day or 4 mg/kg/day) in an open label, emergency-use trial. Patients were then assessed for clinical and microbiological cures and survival. MIC's of isolates to daptomycin were determined.
Results:
Nine febrile, neutropenic patients with VRE BSI received daptomycin. Four of 9 courses (44%) had clinical and/or microbiologic cure. Two of the 5 who failed cure died within 3 days of initiation of daptomycin. Five subjects survived to 30 days after the onset of BSI.
Conclusions:
Use of daptomycin in neutropenic patients with VRE BSI deserves further study as a treatment for VRE BSI in neutropenic patients.
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