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Successful treatment of a neonate with persistent vancomycin-resistant enterococcal bacteremia with a

Christy A Beneri1, David P Nicolau, Howard S Seiden

  • 1Pediatric Infectious Diseases, Schneider Children's Hospital - North Shore-LIJ Health System, New Hyde Park, New York, USA;

Infection and Drug Resistance
|June 23, 2011
PubMed

Insights

Vancomycin-resistant enterococci (VRE) infections are challenging in neonates. A novel daptomycin regimen successfully treated VRE bacteremia and probable endocarditis in a 3-week-old infant.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Vancomycin-resistant enterococci (VRE) infections pose significant treatment challenges, particularly in neonates due to limited approved antimicrobial options.
  • Pediatric VRE infections require careful consideration of drug safety and efficacy in this vulnerable population.
  • Complex congenital heart disease and acute renal failure can complicate VRE infections in neonates.

Observation:

  • A 3-week-old infant with complex congenital heart disease developed VRE bacteremia post-surgery.
  • Despite multiple antimicrobial agents including linezolid and quinupristin/dalfopristin, the infant's bacteremia persisted.
  • The infant also experienced acute renal failure, further complicating treatment decisions.

Findings:

  • A combination regimen of daptomycin and doxycycline was initiated for persistent VRE bacteremia.
  • This daptomycin-containing regimen successfully cleared the VRE bacteremia in the neonate.
  • This represents the first reported case of successful VRE endocarditis treatment in a neonate using daptomycin.

Implications:

  • Daptomycin may be a viable treatment option for VRE infections in neonates when other agents fail.
  • Further research is needed to establish optimal dosing and safety of daptomycin in pediatric populations.
  • Successful VRE treatment in neonates expands therapeutic options for multidrug-resistant infections.
Keywords:
daptomycinendocarditisenterococcusneonatespediatrics

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